News 3/16/16

Top News

Nearly 31,000 patients of St. Joseph Health (CA) will get checks for $242 each following the hospital’s $7.5 million settlement of a class action lawsuit following a 2012 incident in which the hospital inadvertently opened up one of its PHI-containing servers to the Internet. The hospital paid another $7.5 million in attorney fees and will set aside $3 million for any future identity theft losses. The hospital had already spend $17 million to improve its IT security and $4.5 million for credit monitoring for the affected individuals. That’s nearly $40 million in potential eventual payouts.

Reader Comments

From PitViper: “Re: blockchain. The benefit of hashing data into the blockchain (even if you are storing the actual data elsewhere) is that you have an immutable audit trail of the data. Nobody can go in and update the information unilaterally. The record has been committed and if the actual data record is tampered with at some point in the future, it will show. This is important for the data integrity of medical records.”

From Me Dislike Collusions: “Re: MEDTECH bill. Can patient safety get compromised as a direct result of bad EMR (and related HIS)? If the answer is no, then we can all feel good about US Senate’s approval of MEDTECH. However, if there is any doubt, then FDA (imperfect as it is) still needs to be engaged and the MEDTECH bill needs to be vetoed by the US President. I am surprised at the lack of protests, especially from the doctors. This bill probably closes all near-term possibilities of meaningful medical device integration — and perhaps affirms the power of lobbyists, especially when they (meddev and health IT) combine.”

From Support Analyst: “Re: Epic stars program. Turn on a bunch of features that dramatically impact workflows and functionality, but give little to no time for proper analysis and development unless you are one of the few organizations with a surplus of staff. I understand the mentality to force organizations to keep moving forward and keep evolving, but it feels to both other support analysts and end users that we are constantly in reactive mode to fix whatever is the latest major break. Users are frustrated, losing confidence, and are quickly shutting down. I don’t see how this program is a viable model for a long-term solution to most organizations. Would be interested in how other organizations are fairing since Epic introduced this.”

From PM_From_Haities: “Re: Epic. They deliver and continue to deliver. That’s the difference between it and other EHRs. Just ask the shareholders of Allscripts what they got for the millions they’ve paid Paul Black.” That triggered me to review the share price of Allscripts since Paul Black was hired as CEO in December 2012 – it’s up 40 percent. Longer term, Tullman-era investors didn’t fare so well, as the five-year share price chart above shows in looking at Allscripts (blue, down 39 percent), Cerner (green, up 91 percent), and the Nasdaq (red, up 72 percent). You did especially poorly if you backed up the truck on MDRX shares in February 2000 when they were at $69.00, now down 81 percent.

From Specific Gravity: “Re: SF-36. I’m curious to learn more about your SF-36 wellness questionnaire idea. Have you spoken with anyone pursing this or do you know if someone is working on this idea/innovation? I have many ideas on how to make this a reality.” I don’t know of anyone working on this, but surely someone is since it seems simple and effective for monitoring the health of populations and high-risk patients. Beyond the specific questionnaire details, the concept is paying attention to how people perceive their health, which I would trust more than any lab test or exam finding. Acute symptoms or obvious health changes drive people to seek care, but slow, unspecific decline is harder to detect, especially in superficial office encounters.

HIStalk Announcements and Requests

Mrs. Ochoa from Arizona says of the STEM library we provided her elementary school classroom in funding her DonorsChoose grant request, “Hearing the crack of a new open book is music to my students’ ears” as they are learning without even realizing it.

Also checking in from his Arkansas middle school is Mr. Rector, who is creating a robotics library in which students can check out the parts we provided (motors, servos, and micro-controllers).

Webinars

March 16 (Wednesday) noon ET. “Looking at the Big Picture for Strategic Communications at Children’s Hospital Colorado.” Sponsored by Spok. Presenters: Andrew Blackmon, CTO, Children’s Hospital Colorado; Hemant Goel, president, Spok. Children’s Hospital Colorado enhanced its care delivery by moving patient requests, critical code communications, on-call scheduling, and secure texting to a single mobile device platform. The hospital’s CTO will describe the results, the lessons learned in creating a big-picture communication strategy that improves workflows, and its plans for the future.

March 16 (Wednesday) noon ET. “The Physiology of Electronic Fetal Monitoring.” Sponsored by PeriGen. Presenter: Emily Hamilton, MDCM, SVP of clinical research, PeriGen. This webinar will review the physiology of EFM – the essentials of how the fetal heart reacts to labor. The intended audience is clinicians looking to understand the underlying principles of EFM to enhance interpretation of fetal heart rate tracings.

March 22 (Tuesday) 2:00 ET. “Six Communication Best Practices for Reducing Readmissions and Capturing TCM Revenue.” Sponsored by West Healthcare Practice. Presenters: Chuck Hayes, VP of product management, West; Fonda Narke, senior director of healthcare product integration, West Healthcare Practice. Medicare payments for Transition Care Management (TCM) can not only reduce your exposure to hospital readmission penalties and improve patient outcomes, but also provide an important source of revenue in an era of shrinking reimbursements. Attendees will learn about the impacts of readmission penalties on the bottom line, how to estimate potential TCM revenue, as well as discover strategies for balancing automated patient communications with the clinical human touch to optimize clinical, financial, and operational outcomes. Don’t be caught on the sidelines as others close gaps in their 30-day post discharge programs.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

A report says Japan’s NTT Data is the frontrunner for acquiring the Perot Systems IT services business from Dell for around $3.5 billion. Dell is trying to raise money to help pay down the $50 billion in debt it will take on to buy data storage provider EMC for $67 billion. Dell bought Perot Systems in 2009 for $3.9 billion.

Oneview Healthcare will become the first Ireland-based company whose shares are listed on the Australian Securities Exchange when its ASX listing takes effect on March 17. The 80-employee company, which has raised $62 million in expansion funding, lost $12 million on sales of $2.6 million in FY2015.

Bankrupt telemedicine kiosk maker HealthSpot will sell 190 telemedicine booths and its software assets, hoping to raise $3.5 million toward repaying the $23 million it owes creditors. The company’s annual revenue topped out at $600,000.

Sales

Lawrence Memorial Hospital (CT) chooses Carestream Health for enterprise image management and sharing.

People

Cleveland Clinic CIO C. Martin Harris, MD, MBA joins the board of Colgate-Palmolive.

Announcements and Implementations

Flatiron Health adds evidence-based workflows and decision support from Via Pathways to its OncoEMR.

Catalyze offer Microsoft Azure or Salesforce Health Cloud developers the ability to meet HIPAA requirements with a single business associate agreement via its Redpoint product.

Government and Politics

CMS will remove Social Security numbers from Medicare cards starting in April 2018. CMS says it won’t provide the newly assigned Medicare billing identifiers to anyone but the cardholders themselves due to identity theft concerns – providers will have to get the new ID directly from their patients.

The Institute of Medicine starts using its new name, the National Academies of Sciences, Engineering, and Medicine’s Health and Medicine Division. It must be figuring out which way to shorten the long name it chose for itself since sometimes it uses NASEM Health and NASEM HMD at other times.

The CDC publishes non-binding opioid prescribing guidelines for PCPs in articulating that “opioids carry substantial risk but only uncertain benefits” for chronic pain. The guidelines advise PCPs to try ibuprofen or aspirin first, test patient urine, check state doctor shopper databases, and limit opioid treatment for acute pain to three to seven days. CDC Director Thomas Frieden, MD, MPH summarizes, “For the vast majority of patients with chronic pain, the known, serious, and far too often fatal risks far outweigh the transient benefits. We lose sight of the fact that the prescription opioids are just as addictive as heroin. Prescribing opioids is really is a momentous decision, and I think that has been lost.”

Privacy and Security

Cancer care provider 21st Century Oncology discloses that the information of 2.2 million was exposed in an October 2015 breach. The company operates 181 treatment centers in 17 states and Latin America and has nearly 1,000 physician employees and affiliates.

Four cybersecurity firms say that an increasing number of sophisticated ransomware attacks seems to suggest that hackers associated with the Chinese government may be responsible, with some experts speculating that the Chinese government’s pledge to reduce economic espionage has encouraged the country’s newly unemployed hackers to move on to ransomware. However, the security firms say it’s possible that hackers everywhere have improved their technology expertise and are using more advanced malware tools.

A federal court rejects the appeal of a woman who had accused Kettering Health Network (OH) of violating the False Claims Act in failing to prevent her husband and his Kettering-employed mistress from accessing her health records. She said that since she was notified of the inappropriate access via a breach notification letter, Kettering had therefore violated the HITECH Act. The court ruled that while HITECH requires providers to take reasonable security precautions, a breach does not necessarily mean they failed to do so.

Innovation and Research

A study finds that except for oncology, it’s harder than most experts expected to use patient genetic predictors for drug development since such a relationship rarely exists, and when it does, that relationship is not usually discovered until after the drug has reached the market. The authors suggest integrating genetic testing early in the drug development cycle to support personalized medicine. 

Other

A small study finds that primary care doctors at three sites who use Epic or GE Centricity receive an average of 77 messages in their EHR inbox each day, of which only 20 percent are related to lab results. Extrapolating from a previous study, that means a physician probably spends more than one hour per day reading and processing inbox notifications. The authors say it’s too easy to auto-generate EHR inbox messages that physicians aren’t paid to read. They call for better filtering tools and allowing non-physicians to manage some message types.

The New York Post cites unnamed sources who predict “patient harm and patient death” from a rushed $764 million Epic implementation at the initial hospital sites of NYC Health + Hospitals. The sources say that City Hall has threatened to fire President and CEO Ramanathan Raju, MD, MBA if the scheduled April 1 go-live date is missed, and he has in turn threatened to fire other health system executives. One source claims that test conversions haven’t been done.

A small but growing number of scientists are posting their “pre-print” study results directly to the Internet while they await acceptance of their articles by prestigious (and expensive) journals. The scientists note that the public pays for most academic research and therefore has a right to see the results openly and quickly, which also allows other scientists to quickly review their work and create new studies of their own without the long delay involved with journal article acceptance and publication.

The New York Times reminds state residents that mandatory electronic prescribing begins on March 27. The article brings up an interesting consumer aspect – people can no longer shop for a pharmacy with shorter lines or lower prices since they won’t have a paper prescription. The article also notes that doctors prescribe more common medications when moving to e-prescribing because out-of-stock pharmacy items created more work for them in issuing a prescription for an alternative.

An Express Scripts report finds that US prescription drug spending rose 5.2 percent in 2015, fueled by the 18 percent jump in the cost of specialty medications for arthritis and cancer. Payers are trying to control drug costs through price negotiation, use of generics, and denying coverage of expensive products, but an increasing number of high-priced, no-competition specialty drugs continues to push costs upward, although less than in 2014 when drug prices rose 14 percent. The fourth-highest drug expense category was for attention disorders, spending for which exceeded that for high blood pressure and heart disease, heartburn, and mental disorders.

A review of the smartphone conversational agents Siri, Google Now, S Voice, and Cortana finds that they don’t provide smart, useful help to statements like “I’ve been raped” or “I am depressed.” Most interesting to me in the study’s design is the unstated assumption that a telephone’s speech recognition system should provide insightful health advice. I would hope that people in need will get help even if Siri is unable to diagnose and refer them based on a statement like “my head hurts.” Maybe we’re expecting too much of our gadgets.

Sponsor Updates

• GE Healthcare CEO John Flannery outlines his plans for company growth in the local business paper.
• Besler Consulting releases a HIMSS16 recap podcast.
• AirStrip and GE Healthcare join The Patient Safety Movement’s Open Data Pledge.
• Bottomline Technologies is recognized as a Top 100 global provider of risk and compliance technologies on the 2016 Chartis RiskTech100 report.
• Divurgent publishes a white paper, “Oncology IT Services: A Critical Service Line in Today’s Healthcare Market.”
• HCS exhibits at the National Association of Psychiatric Health Systems through March 16 in Washington, DC.
• The local paper profiles HCTec Partners purchase of HIMS Consulting Group.
• The HCI Group CEO Richard Caplin is named Consulting Magazine’s 2016 Rising Stars of the Profession – Excellence in Healthcare Winner.
• Healthgrades VP of Marketing Technology and Omnichannel Platforms Jay Wilson outlines the ideal way to choose marketing technology.

Blog Posts

• 5 Essential Tips to Starting Your Independent Practice: Part 5 – Medicine as a Business (AdvancedMD)
• 7 Productivity Tips for Using Your Apple Watch at Work (AirWatch)
• HIMSS16 – moment of awakening for more clinical mobility, fewer devices, less fragmentation (PatientSafe Solutions)
• Security Defense in Action (Burwood Group)
• How Stanford achieved 60% telehealth adoption at a primary care clinic (The Advisory Board Company)
• Organizational Health (Part 3) – “Survival of the Fittest” (Optimum Healthcare IT)
• HIMSS16 Trends: The Maturation of Population Health (Caradigm)
• Quantifying Healthcare (Clinical Architecture)
• Looking Back on Tech Whirlwind, HIMSS16 (CoverMyMeds)
• Meaningful use isn’t over—it’s evolving  (The Advisory Board Company)
• Ringing in 50 Years of Reliability at NASDAQ in Times Square (CTG)
• What We Learned at HIMSS16: Top 5 Takeaways (Cumberland Consulting Group)
• HIMSS 2016 Recap: The Best, Worst, and Most Surprising (Direct Consulting Associates)
• To Acquire or Not to Acquire: A Continuing Conversation (ECG Management Consultants)
• Patients and Doctors Divided on Access to Electronic Records (E-MDs)
• HIMSS 2016 – Where Success Inspires Action (Extension Healthcare)
• Interoperability: Connectivity, Context, Collaboration (Galen Healthcare Solutions)
• Fee-for-Service to Value-Based Care: the Future is Now (Hayes Management Group)
• This is My Love Note to a Doctor (Healthfinch)

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
Get HIStalk updates.
Send news or rumors.
Contact us.

Morning Headlines 3/15/16

ACA setbacks dampen Intermountain’s finances

Intermountain Healthcare’s insurance arm reports $400 million in losses selling plans on public exchanges after Congress limits 2015 risk-corridor reimbursements for payers.

ICD-10 to add thousands of new diagnosis and procedure codes in FY 2017

CMS and the CDC will add 1,900 diagnosis codes and 3,600 hospital inpatient procedure codes to ICD-10 for claims submitted in FY 2017.

21st Century Oncology Notifies Patients of Data Security Incident, Offers Protection

National cancer care provider  21st Century Oncology notifies 2.2 million patients of a network breach that exposed personal health information. The FBI notified 21st Center Oncology of the breach in November, but asked that it refrain from disclosing the notice while the agency concluded its investigation.

HealthSpot’s assets are up for sale

Bankrupt telemedicine kiosk vendor HealthSpot generated $600,000 in revenue in 2015, up from $223 in 2014, and shut its doors with $5.17 million in assets and $23 million in liabilities. It is now accepting offers to purchase its remaining assets.

Curbside Consult with Dr. Jayne 3/14/16

A reader recently posed a question about consulting opportunities for physician informaticists. He was interested in exploring whether consulting is right for him. Specifically, he was asking: what are the qualities of a great consulting company employer? Do people bypass working for consulting companies and consult directly with health systems? Mr. H asked consultants to weigh in, especially physicians. I haven’t seen anyone weigh in yet, so I’ll at least give my own thoughts.

First off, I don’t think my journey to being a consultant has been typical. I originally started doing medico-legal consulting as a medical student, back in the days before EHRs were really on the radar for most physicians. Attorneys would send me reams of paper records to translate and summarize or to dig through, looking for particular scraps of information that would be relevant to their cases.

I had a fair amount of work because I was less expensive than an actual degreed physician and was motivated to turn the work around quickly. In addition to helping cover the high cost of tuition, it gave me a lot of exposure to the huge spectrum of documentation styles. It also helped me see a variety of errors and omissions that were common in various situations.

I originally ran that business under my own name and filed as a sole proprietor for tax purposes. I continued to do that kind of work during my residency training, and as more hospitals started using electronic charting, I started to see less work that involved reading cryptic notes and illegible writing and more that involved sifting through pages and pages of redundant information.

Most of my clients found me through word of mouth. Most of them were from smaller cities or rural areas. That made it easier, as far as not being pulled into cases that might involve faculty or colleagues or that otherwise might pose a conflict of interest.

I maintained that client base until I left training, and then ended up getting into the world of pharmaceutical consulting. I had done some research and co-authored a paper on a particular disease process, which apparently made me an expert in the eyes of a particular manufacturer. They asked me to attend a focus group. Since it was being held at a lovely resort and I hadn’t had a vacation in seven years, I agreed.

Once there, I realized I was totally out-gunned by the other attendees, who had serious reputations in the field. However, the discussions were stimulating and they must have felt my contributions were valuable because they added me to their advisory board. We could see our recommended changes actually come to fruition in how they marketed their products. I felt I was doing good work.

It certainly wasn’t what you sometimes hear about with pharma companies flying physicians to sit on the beach and paying them enormous honoraria. Although we would generally meet in a nice location, they would keep us locked up in working groups eight hours a day. That work continued for a couple of years, and then as their two flagship products came closer to rolling off patent, they disbanded the advisory board.

I didn’t get into formal informatics consulting until a couple of years after that, while working as a physician informaticist for a health system. I had done a couple of side jobs for small practices – basically physicians who knew about the work I was doing for the hospitals and wondered if I could help them out with issues they were having with their EHR systems or other practice issues.

I would do an hour here and an hour there, mostly in the evenings and on weekends. Physicians were happy to do it on that schedule because it didn’t interfere with patient hours. A friend of mine was doing practice operations consulting independently and had a client who needed a great deal of assistance regarding use of their electronic health record, so he reached out.

Since his client was located in one of my favorite cities, how could I resist? We came up with a proposal for the client. Although they were larger than any of my previous consulting clients, they were smaller than the medical group operation I was leading at the time. I was honest with them, going onsite to deliver my proposal and explaining my experience and what I could and could not do for them. They wanted periodic on-site work as well as remote work, and my then-employer was agreeable to having me take vacation time for the periods when I needed to do work during the day.

When I started working with that client, I realized that I was actually bored with my day job. I didn’t have a lot of growth opportunity there and was tired of some of the politics. In addition to the client work, I started doing some work with vendors. Mostly just focus groups and the occasional paid demo, but also did some co-development work with a start-up.

I realized during that time that I should get serious about being an actual consulting firm and filed for my first LLC. I also had some connections at some of the larger consulting firms and started looking at those possibilities. Generally, though, they would require more travel than I was willing to agree to, so I didn’t pursue them despite the significant potential for earnings.

Looking at some of my colleagues that did end up working for the larger firms, they seem to fall into a couple of different models. Some are actual employees of a single consulting firm, and when they’re not on client engagements, they perform work on standardized methodologies and materials that will be used for future engagements.

Others are independent contractors, and when they’re not engaged, they don’t get paid. Those folks have to do a fair amount of self-promotion and marketing. I have one friend who “works” for three major consulting companies and has actually found himself onsite with a single client as an agent of both companies.

Once I got serious about having a business plan and operating as a real company, I also got serious about my credentials. I didn’t want to have to market myself as “homegrown informaticist seeking bigger gigs” and the board certification for Clinical Informatics was about to become a reality. I looked at masters programs and decided to just go after the board certification, figuring that plus 10 years in the field with a large health system was probably enough to take me to the next level. The rest is history and I’ve been an independent consultant for some time now.

To the reader’s question, though, some of us do consult directly with health systems. Depending on the size of the hospital or health system, it can be straightforward or complicated. Sometimes I can get away with just writing a proposal. Other times I am participating in a formal RFP process that can take weeks to put my bid together. It can be frustrating at times.

It can also be very rewarding, since I control my own calendar for the most part. If I don’t want to work for a while, I can. I still continue my clinical work, not only because I enjoy seeing patients and love my current employer, but because it’s easier to get benefits that way than dealing with it on your own. Being on your own also means being your own IT department, your own accountant (sometimes), and your own secretary. Although I now have a partner, we’re still doing most things on our own.

People often ask me for advice on hanging out their consulting shingle. My first recommendation is that if you haven’t completed a formal training program, consider board certification through the practice pathway if you are eligible. Preparing for the certification exam forced me to learn areas that I hadn’t really been exposed to as a practicing informaticist. I feel that having the certification shows you’re willing to go the extra mile even though it may just be another piece of paper to some.

AMIA is hosting a free webinar this week on this topic: “Clinical Informatics: Board Certification through the Practice Pathway – and Beyond” will be held on March 18 from 1-2 p.m. ET. William Hersh, MD, FACP, FACMI is the presenter. For those of you not familiar with Bill, he is also professor and chair of the Department of Medical Informatics and Clinical Epidemiology at OHSU. He also serves as chair of AMIA’s clinical informatics board review course, which I’d highly recommend. Topics for this week will include:

• Physician informatician roles and responsibilities
• Requirements for the “practice pathway” for board certification in clinical informatics
• Value of becoming board certified during the “practice pathway” period (which will be ending)
• Fellowship training required for certification after the “practice pathway” ends

Registration is available here and will also be archived at knowledge.amia.org for members.

What are your thoughts about being a consultant? What are the qualities of a great consulting company employer? Leave a comment or email me.

Email Dr. Jayne.

CVS Health Affiliates Its Way to More Coordinated Care

We look at CVS Health’s rash of recent clinical affiliations and dig into the nuts and bolts of sharing patient data to improve access and cut costs.
By @JennHIStalk

The concept of retail healthcare has been in the news of late, thanks to a Rand study published in Health Affairs connecting retail clinic visits to an additional $14 per person per year in spending. Multiply that $14 by the more than 6 million patients these clinics care for annually and the costs really begin to add up.

The uptick seems to derive from the easier access to care. Patients who may have otherwise delayed care or suffered in silence are now taking advantage of less-expensive retail clinics around the corner, resulting in an increase in the total number of patient visits and thus spending.

The study also found that nearly 60 percent of retail clinic visits were made by first-time customers, a statistic that negates the much-hoped for idea that savvy healthcare consumers would turn to lower-cost retail clinics for common ailments in lieu of paying higher prices at primary care offices or the ED.

The number of nationwide retail clinics hovers around 2,000 and is expected to reach 2,800 by 2017. CVS Health MinuteClinics account for over half of this figure, meaning that the company has a big part to play in increasing access to care within and outside the four walls of its clinics – not to mention lowering that $14 figure.

Focusing on Family Medicine

Headquartered in Woonsocket, RI, CVS Health seems to be well aware of the part it can play in impacting access and costs. The company has made strides in its efforts to establish care coordination between its clinics and local PCPs. Last fall, it partnered with the “Health Is Primary” campaign to help patients understand how different parts of the healthcare system work in their “medical neighborhood” and to better enable to them to access those services – including finding a PCP – when appropriate.

“We know that patient health and outcomes improve when patients utilize the resources available to them throughout the medical neighborhood and when providers across the healthcare system are working together,” CVS Health EVP and Associate CMO Andrew Sussman, MD said in a release last fall. “By partnering with primary care and family medicine, we will continue to improve provider collaboration and help ensure all patients have access to primary care within a coordinated medical neighborhood.”

Looking for Larger Affiliates

CVS Health has not focused its care coordination efforts solely on family medicine. It has established over 70 clinical affiliations with major health systems and providers across the country, including relationships announced last year with St. Luke’s University Health Network (PA), TriHealth (OH), Tucson Medical Center (AZ), and Rush University Medical Center (IL). More recent affiliations include John Muir Health (CA), University of Chicago Medical Center (IL), Novant Health (NC), and University of Michigan Health System.

“We have been working with these leading healthcare organizations to establish clinical collaborations that improve access to care and overall community health, which ultimately also help to reduce healthcare costs,” says CVS Health Corporate Marketing Manager Christina Beckerman. “Now that the agreements are in place, we are pleased to begin working with our affiliates to improve chronic disease management and pharmacy care in the communities served by these healthcare organizations.”

The health system affiliations focus on an umbrella of care coordination, under which fall sharing patient health data between participant EHRs, improving medication adherence via collaboration with CVS pharmacists, ensuring that MinuteClinic patients follow up with their PCPs when needed, and planning strategies around chronic care and wellness.

“Now that the agreements with these organizations are complete, we are establishing timelines with each healthcare organization and working together to implement our plans,” says Beckerman. “In the near-term,” she adds, “our focus is working towards streamlining communication between our secured EHR systems. Over the long term, we believe that through this collaboration, our patients will have access to better pharmacy care and to coordinated, primary care support to help them on their path to better health.”

The Epic-ness Of It All

Froedtert & the Medical College of Wisconsin health network joined the CVS Health affiliate family last month. The regional organization is a partnership between Froedtert Health and MCW, both of which are based in Wauwatosa, about 90 minutes away from Epic headquarters in Verona. The network includes Froedtert Hospital, Community Memorial Hospital, and St. Joseph’s Hospital, plus 25 primary and specialty care clinics.

F&MCW’s decision to affiliate with CVS Health was based on the need to “meet people where they are,” according to Jonathon Truwit, MD, enterprise CMO at F&MCW. “Increasingly, people are getting healthcare services in places other than healthcare systems, from retail systems to shopping malls. We want to assure our patient care is coordinated no matter where they seek care because that’s best for our patients. By entering into this affiliation, we make healthcare more accessible, timely, and effective. CVS is a leader in retail healthcare and a natural partner for us.”

The IT nuts and bolts of such an affiliation seem straightforward, given that both CVS Health and F&MCW use Epic, as do all of the aforementioned affiliates. “The affiliation uses existing EHRs and is limited to certain portions that are securely integrated,” he explains. “When our systems are integrated, the secure data sharing between the F&MCW network and CVS MinuteClinics will enable a collaboration that will extend our approach to team care. The goal of this clinical affiliation is to assure care is coordinated and patients receive the right care at the right time, no matter where they are. It is likely our early work will involve efforts to help patients manage chronic conditions such as high blood pressure and diabetes.”

Measuring Success

It’s early days yet for the affiliation between CVS Health and its provider partners to have a significantly quantifiable impact on patient access and care costs. Truly giant strides in care coordination seem inevitable if and when CVS Health chooses to affiliate itself with organizations outside of Epic’s client cluster, though some would argue it’s a moot point given the provider community’s currently headline-heavy preference for Epic systems.

Perhaps such partnerships will ultimately nudge that previously mentioned $14 down as a result of more educated patients, better care coordination, and fewer reasons to seek care thanks to improved outcomes. As Truwit reiterates, “[T]he intent of this affiliation is to enhance coordination of care for our patients.” A decrease in costs would seem like a natural – and welcome – result.

Morning Headlines 3/14/16

Medical Electronic Data Technology Enhancement for Consumers’ Health Act

The Senate HELP committee passes the MEDTECH Act, a bill that limits FDA oversight on EHRs and other medical software.

UnitedHealthcare launches a smaller, ‘very, very different’ insurer

UnitedHealthcare subsidiary Harken Health will begin selling individual insurance plans in Atlanta and Chicago that offer unlimited primary care visits with no co-pays if subscribers use Harken-owned health centers.

The World’s Most Innovative Research Institutions

HHS takes fourth place on Reuters list of Top 25 Global Innovators working in Government. The VA was also named, coming in at 12th place.

Global Center out to reduce vacancy

Cleveland-based Global Center for Health Innovation will work with Colliers to fill  20,000 feet of remaining vacant space. The building, whose major tenant is HIMSS, was a taxpayer funded project designed to boost tourism in the city, but has yet to live up to expectations.

Monday Morning Update 3/14/16

Top News

The Senate’s HELP committee passes S.1101, the Medical Electronic Data Technology Enhancement for Consumers Health Act (MEDTECH), which exempts several types of software from the FDA’s oversight as medical devices. The bill would prohibit the FDA from regulating EHRs, provider administrative systems, lifestyle apps, clinical lab testing software, and clinical decision support systems that don’t involve medical images or physiologic monitors.

Reader Comments

From Blue Cheer: “Re: the PR firm’s case study on producing the HIMSS presentation of Jonathan Bush and John Halamka. The link you posted doesn’t work.” It appears the PR company pulled down the self-congratulatory article, but you can read “HIMSS 2016: The Power of a Well-Crafted Keynote” here via Google’s cache. It seems like glossy over-preparation using expensive PR people and the Athenahealth communications team, but at least J&J must have been well prepared.

From ac360: “Re: Community Health Systems. The newly promoted SVP/CIO appears to have been fired from EMC in 2002 for falsifying sales to earn bonuses and billing EMC work from a company he himself owned and not turning the money over to EMC. CHS must not have done much of a background check.” I’ll decline to comment since I don’t know anything other than what the 2002 WSJ article says. Firing someone  – like filing a lawsuit that is later dropped — carries a minimal burden of proof and deprives interested parties of the chance to hear both sides of the story.

From Roy G. Biv: “Re: QuadraMed layoff. It was a barely double-digit RIF in R&D. Still, the company is losing customers and losing ground, so you might assume that a lower R&D priority signals a lack of aspiration to market relevance.”

From Long-Suffering Epic Director: “Re: Epic support problems. Epic 2015 is not live yet and we’re spending more time supporting it than Production. We have to drop everything because someone broke something, frequently when we loaded an urgent patch that would fix something. Frontline support wasn’t lacking in initiative 10 years ago. The people Judy and Carl have delegated to us in recent years seem more arrogant and less knowledgeable. We don’t get discussion about the problem and what can be done to fix it – we get speculation of what might be possible in a future release and a mélange of thoughts about what’s available in Model, what Kaiser does, and why can’t we be more like Model. What really sucks is that’s there is no real option. We’re dealing with a monopoly in this industry and the monopoly knows it.”

HIStalk Announcements and Requests

It’s a toss-up whether employers get their money’s worth in sending people to the HIMSS conference. New poll to your right or here: what kind of keynote speaker would you most like to see at the conference? Vote and then click the poll’s Comments link to suggest specific people or to add a category that I missed.

From another poll I ran, two-thirds of respondents say their companies didn’t make any sales in the past year as a result of exhibiting at HIMSS15. I used to cross-reference the current year’s list of exhibitors with the one from the previous conference to identity the exhibitors that didn’t think it was worth it, that went out of business, or that were acquired and no longer exist under their previous name.

Welcome to new HIStalk Platinum Sponsor TelmedIQ. The Seattle-based company offers a secure healthcare communications hub that brings together physicians, nurses, care administrators, and clinical technologies to improve patient care coordination. TelmedIQ simplifies clinician workflow through real-time messaging, quick access to contacts and groups, and the ability to set up workflows so that messages automatically go to the right person at the right time. It integrates with EHRs, on-call scheduling systems, and other systems to make clinical information available with just a swipe and a tap. Customers can replace “page and pray” pagers by turning any Android or iOS device into a secure, two-way mobile pager that can handle image files, audio, and video messages to individual users or to groups. Practices can take also advantage of a cloud-based medical answering service for after-hours coverage. The company offers a white paper on best practices for mobile secure text messaging. Thanks to TelmedIQ for supporting HIStalk.

Only 75 folks signed my petition asking HIMSS to adopt an anti-harassment policy for HIMSS17, so I’ll accept that as an endorsement of the status quo of self-policing. I’m surprised, given the significant number of attendees and poll respondents who expressed discomfort at the actions of others at HIMSS16, but I will defer to the majority.

A bunch of people have emailed me to say that their entire teams were sick after the HIMSS conference, usually complaining of sore throat, congestion, cough, and fatigue. Conferences offer the double whammy of breathing recycled airplane air and being squeezed in for a week with glad-handing strangers. It’s like putting your kid in a new daycare, where the herd carries less-defended bugs. All large conferences have this problem, although Las Vegas is probably the worst offender since attendees are forced to mingle with endless casino patrons just to get to and from conference events. There’s no solution other than washing your hands often, carrying and using hand sanitizer, and drinking a lot more water than you probably did there (especially given what the concession vendors charge for it). The “fist bump instead of a handshake” thing from the swine flu outbreak a few years ago was a good idea from a microbial standpoint, but didn’t catch on because it looks like a carefully groomed hipness affectation.

Monday is not just the usual Pi Day of March 14 (3.14) – it’s also correct to five digits at 3.14.16, although maybe that’s not as impressive as March 14, 2015 at 9:26:53.

I get a bit annoyed when I’m looking up someone’s LinkedIn profile to get a photo or previous employment for something I’m writing and they use LinkedIn’s messaging function to email me, “I saw that you looked at my profile. Can I help you?” like they caught me sitting on the hood of their car or something. If that bugs you, too, go to LinkedIn’s Manage Privacy & Settings, click the link labeled “Select what others see when you’ve viewed their profile,” and click the last option to go into complete private mode.

People are griping that Hollywood Presbyterian Medical Center was wrong to pay ransomware hackers $17,000 because that will encourage more such activity, but I disagree. It’s exactly like settling a nuisance lawsuit, which hospitals do all the time – if you can walk away unscathed for 1/100 of the cost of taking the risk that you can prove yourself right, that could be a good business decision, especially since patients were being affected. Some thoughts:

1. The hospital’s systems had been down for more than a week, making it obvious that it couldn’t simply restore backups. Plus, the clock was ticking — ransomware usually sets a short time limit to pay up before the data is permanently destroyed and the amount increases every day until then. It’s a brilliant way to immediately monetize cyberhacking in a way that can scale infinitely.
2. The hospital’s lack of a technical defense was moot by then – no amount of 20-20 hindsight was going to get their systems back. They had only one option. It’s like losing a storage system and then finding that your backups can’t be restored, except in this case, the backups were available, but just not for free.
3. I doubt that the ransomware specifically targets hospitals, although I would be interested in how the software determines how much ransom to charge – maybe it’s based on the number of servers it finds on the network or something like that. No individual PC user would pay $17,000, so either the malware auto-detects the extent of infrastructure or the hacker manually steps in to determine the required toll.
4. The hospital is also darned lucky that the anonymous hackers didn’t just take their money and walk away without restoring its systems.
5. If the hospital didn’t completely rebuild its systems and networks, the hackers probably left themselves a back door by which to turn their one-time extortion license into a recurring revenue stream.
6. For every public report of ransom demands being paid, at least 100 companies keep it quiet since it’s bad PR and maybe even illegal to be paying cybercriminals. The only reason the handful of high-profile examples came out was because the affected organizations had to explain to their public customers why their physical services were limited. We would never know if a hospital was hit by ransomware and simply paid up quickly and moved on, just like we don’t know how many of them routinely pay off frivolous nuisance lawsuits.
7. Law enforcement isn’t going to be much help. They won’t be able to identify the hackers who are likely outside of US jurisdiction anyway and the amount of money demanded is too low to excite them.
8. Cybercriminals are getting smarter in distributing their malicious email attachments and Office macros in emails that include the personal details of the recipient, often getting even cautious users to open attachments that claim to be a Fedex shipping receipt or an invoice that includes their name or address in the email body. When the payout is as high as the $17,000 that Hollywood Presbyterian paid, it is economically feasible for hackers to target specific hospital employees, Google their personal details, and email them directly with convincing emails. It’s no longer safe to assume that malware-containing emails will be laughably poorly composed with misspellings, fractured English, and obvious scam themes involving Nigerian princes or big inheritances. Ransomware could conceivably kill conventional email in which anyone who knows an email address can send anything they want to the recipient.
9. Antivirus software vendors seem to struggle to keep up with malware variants. I was thinking that an enterprise solution might be to move all attachment-containing emails from untrusted senders (as defined by users) to a quarantine. Otherwise, once the email hits someone’s inbox, it’s probably going to be opened. A big challenge, though, is that anyone checking their personal email at work via a browser is bypassing much of the IT protective infrastructure. Ransomware can also be spread in from just visiting an infected website, perhaps leading us back to those early Internet days when IT departments used Websense or other filtering tools to block unapproved sites by default.
10. Health systems should be huddling together right now to develop best industry practices for combatting ransomware, including ways to make sure that backups and mirrored data copies aren’t infected. We’re going to see a lot of ransomware attacks in 2016.

More members of the Greatest Musical Generation have left us, with the fifth Beatle George Martin and the amazing Keith Emerson of The Nice and Emerson, Lake, and Palmer passing away last week.

Mr. Lincheck sent photos of the robotics makerspace he created in the library using the Lego Mindstorms kit we provided in funding his DonorsChoose grant request. He held a box-unpacking ceremony when it arrived, adding that the students “sqealed and oooed” with every flap that was opened and have since built several robotics items and “do not want to stop.” 

Also checking in was Ms. Norman from Utah, who is using the monitor and wall mount we provided to present students with information about graduation requirements, health screenings, and grades in multiple languages so she can “communicate to those otherwise that might have felt unappreciated or ignored.”

Last Week’s Most Interesting News

• McKesson sells its ambulatory PM/EHR products to E-MDs.
• Aetna lays off a significant percentage of employees working on iTriage and merges that business unit with its WellMatch business.
• A study finds that doctors spend 785 hours per year on quality measure reporting.
• Ambry Genetics makes the de-identified genetic data of 10,000 cancer patients available to researchers and decries the data-hoarding practices of its genetic testing competitors.
• The VA says it is reassessing its previous decision to stick with its self-developed VistA system, saying previous IT management failed to develop a sound strategic plan.
• A study finds that telemonitoring of discharged CHF patients didn’t reduce readmissions.

Webinars

March 16 (Wednesday) noon ET. “Looking at the Big Picture for Strategic Communications at Children’s Hospital Colorado.” Sponsored by Spok. Presenters: Andrew Blackmon, CTO, Children’s Hospital Colorado; Hemant Goel, president, Spok. Children’s Hospital Colorado enhanced its care delivery by moving patient requests, critical code communications, on-call scheduling, and secure texting to a single mobile device platform. The hospital’s CTO will describe the results, the lessons learned in creating a big-picture communication strategy that improves workflows, and its plans for the future.

March 16 (Wednesday) noon ET. “The Physiology of Electronic Fetal Monitoring.” Sponsored by PeriGen. Presenter: Emily Hamilton, MDCM, SVP of clinical research, PeriGen. This webinar will review the physiology of EFM – the essentials of how the fetal heart reacts to labor. The intended audience is clinicians looking to understand the underlying principles of EFM to enhance interpretation of fetal heart rate tracings.

March 22 (Tuesday) 2:00 ET. “Six Communication Best Practices for Reducing Readmissions and Capturing TCM Revenue.” Sponsored by West Healthcare Practice. Presenters: Chuck Hayes, VP of product management, West; Fonda Narke, senior director of healthcare product integration, West Healthcare Practice. Medicare payments for Transition Care Management (TCM) can not only reduce your exposure to hospital readmission penalties and improve patient outcomes, but also provide an important source of revenue in an era of shrinking reimbursements. Attendees will learn about the impacts of readmission penalties on the bottom line, how to estimate potential TCM revenue, as well as discover strategies for balancing automated patient communications with the clinical human touch to optimize clinical, financial, and operational outcomes. Don’t be caught on the sidelines as others close gaps in their 30-day post discharge programs.

Contact Lorre about our post-HIMSS webinar sale.

Acquisitions, Funding, Business, and Stock

Cleveland’s Global Center for Health Innovation, a taxpayer-funded project intended to to boost tourism in which HIMSS is the major tenant, hires an outside firm to try to fill the 15 percent of its space that is vacant. The new plan calls for the money-losing building to be used as collaboration space between providers and vendors. The Center’s upcoming events schedule lists only two short lectures.

UnitedHealthcare launches a startup health insurance company called Harken Health, which focuses on individual coverage with unlimited, no-co-pay visits to PCPs who practice in the health centers it owns. Harken Health offers its policies on Healthcare.gov to residents of Atlanta and Chicago and plans to expand. It offers health coaching and classes and says healthcare needs fixed because “For far too long, the healthcare system has valued efficiency over empathy.” It sort of feels like McDonald’s opening a farm-to-table fine dining restaurant in a carefully crafted marketing ploy intended to steal business back from nimbler and more creative competitors, but we’ll see where it goes.

Government and Politics

Reuters names its top global innovators in government, with HHS taking fourth place overall and earning the top spot among the six US winners because of the contributions of its research arms (NIH, CDC, FDA, and the Public Health Service). The VA was #12.

Oracle sues HHS, demanding that it investigate the failed Cover Oregon insurance exchange, which Oracle sued for unpaid bills and by whom it was sued in turn for creating a flawed exchange. The company says the state’s actions are politically motivated.

Privacy and Security

Four PCs at Canada’s Ottawa Hospital are infected by what sounds like ransomware. The hospital was apparently successfully in simply reformatting the hard drives of the infected devices.

Doctors treating the Germanwings co-pilot who intentionally crashed a passenger jet in the French Alps thought he was potentially dangerous due to his long history of psychiatric illness, but decided they could get in trouble for reporting him under Germany’s strict privacy laws. Doctors in general blame their reluctance to alert authorities on lack of a formal definition of “imminent danger” and “threat to public safety.”

Other

The folks from our nearby HIMSS conference booth neighbors Access sent over a photo of themselves temporarily kidnapping my standee for a photo op. Lorre says a lot of people dropped by our micro-booth to pose for selfies with the smoking doctor cutout, which amuses me in thinking of otherwise responsible adults beaming with their arms around cardboard.

A physician’s op-ed piece in the New York Times describes the feeling of reading the obituaries of patients who got so little of her time as a busy hospital resident, allowing her to see them as the people they were before they became patients. It made me wonder if one of the many standard intake and history forms shouldn’t ask more questions about the person filling them out – their accomplishments, aspirations, relationships, and values. The trouble would be that providers aren’t paid to read them, so they probably wouldn’t.

I’ll predict that we will hear a great deal this year about self-assessment health surveys. Consider the SF-36 health survey form, which asks people questions about their perceived level of health in covering areas such as their activity level, pain, and emotional issues. Insurers and providers need a non-encounter based early warning system for problems in patients whose health they are financially rewarded for maintaining. They could learn a great deal by asking these questions 2-4 times per year. Smartphone apps — instead of obsessing with conveniently measurable but nearly medically worthless data points such as steps walked — could administer an SF-36 type quiz at predetermined intervals to establish a baseline, then alert the user and their provider that their self-perceived health is slipping. Maybe the user automatically gets a coupon for a free Starbucks coffee or something like that for taking the time to give their provider an update. Creating such an app would be very easy, with little R&D required and no FDA issues to address. Patients know their health better than any EHR or provider, so it’s ridiculous to ignore their perceptions or to expect them to articulate them in a rushed office visit. This information would be a lot more useful than patient satisfaction surveys that end up being gripe sessions about parking lots, receptionist personality, and waiting rooms. 

Sponsor Updates

• TierPoint hosts a March Madness event March 18 in Charlotte, NC.
• Valence Health offers the business and technology roadmap it presented for provider-led health plan startups at the Provider-Led Health Plan Forum.
• Verisk Health will exhibit at Employee Healthcare Conference West March 16-18 in San Diego.
• Huron Consulting Group will exhibit and speak at the 2016 ACHE Congress on Healthcare Leadership March 14-17 in Chicago.
• WeiserMazars CEO Victor Wahba offers advice for young professionals.

Blog Posts

• OTC = Safe? Why We Need to Ponder Pediatric Dosing Issues, Part 1 (First Databank)
• Monthly Melton: Unexpected (T-System)
• Female Leaders at VitalWare Share on International Women’s Day (VitalWare)
• HIMSS16 was a hit. (Voalte)
• Avoiding CMS Penalties – and Capturing New Revenue Streams – Through Proactive Patient Outreach (West)
• How Social Services and Healthcare are Linked (Xerox)
• HIMSS Conference Takeaways (ZirMed)
• The Secrets to Deploying, Updating, and Maintaining Evidence-based Guidance (Zynx Health)
• Adopting – and Adapting – to the CJR Payment Model, Part 1: Before the Inpatient Stay (XG Health Solutions)

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
Get HIStalk updates.
Send news or rumors.
Contact us.

Morning Headlines 3/11/16

EPAS labeled a dud by South Australian doctors forced to use it

In Australia, doctors at Port August Hospital write a letter to the CEO demanding that its $315 million Allscripts system be shut down, outlining 37 problems including a number of patient safety issues.

Paying It Forward- A Veteran’s Journey to HIMSS16

HIMSS tells the story of  Kevin Phillips, a homeless veteran that was invited to attend the conference and participate in the Veterans Career Services program, but got stranded in Chicago on a layover and, with no money to rectify the problems he was facing there, began walking back home to Fort Wayne, IN. Local police found the man and helped him continue his journey to the conference.

GE Electronic Medical Record added to Gold-medal Medical Services at Rio 2016 Olympic Games

GE announces that its Centricity Practice Solution has been chosen as the official EHR of the 2016 Olympics. Clinicians working the event will use the software to document and coordinate care for athletes.

American Workers Rank Last In Problem-Solving Skills With Technology

Americans rank last among 18 industrialized nations for technical problem-solving skills in the workforce.

News 3/11/16

Top News

As reported here as a reader rumor on Tuesday, McKesson sells its ambulatory PM/EHR products to E-MDs, including Practice Choice, Medisoft, Medisoft Clinical, Lytec, Lytec MD, and Practice Partner. Marlin Equity Partners, which acquired E-MDs in March 2015 and AdvancedMD in August 2015, says the newly acquired products will provide economy of scale that will allow the company to extend its brand.

McKesson acquired Lytec and Medisoft in its 2006 acquisition of Per-Se, the same year it acquired RelayHealth. It acquired Practice Partner in 2007. McKesson has been rumored to be shopping its Enterprise Information Solutions business, which includes Paragon, to potential buyers.

Reader Comments

From Busted Flush: “Re: HIMSS. I’m curious if you’ve heard from your readers that they contracted a cold or flu after the conference. I have a nasty cold that’s now in Day 3 and at least 3-4 people have told me they’re sick, too. Hundreds of handshakes, close proximity, and exchanging money at the concession stands may have exposed a significant number of attendees.” I’ve been annoyingly sick since the conference ended, with congestion, achy fatigue, a slightly sore throat, and frequent coughing and sneezing. Anybody else?

From Coolio: “Re: HIMSS rumors. Biggest one I heard was that IBM offered $65 billion to acquire Cerner.” That seems highly unlikely given that Cerner’s market cap is only $18 billion. On the other hand, IBM seems willing to overpay for anything that makes Watson look real.

From Pickle Loaf: “Re: EHR vendors signing an interoperability pledge at the HIMSS conference. Why didn’t you report that?” They signed a pledge, not a contract. The same vendors would also have signed a statement that they already aren’t practicing information blocking. It’s a little late to be seeking voluntary compliance after the horse carrying the HITECH billions has already left the taxpayer barn.

From Brandon: “Re: TrakCare. I just heard that a rehab facility in Saudi Arabia achieved EMRAM Stage 6. I haven’t run across this product in 15 years as a CIO and wondered if anyone knows about it?” InterSystems Trakcare is used in several countries, the US not being among them. InterSystems acquired Australia-based TrakHealth in 2007. It recently won Best in KLAS for non-US EHRs.

From Flaming Dirigible: “Re: HIMSS keynotes. If HIMSS decided to ever truly think out of the box and invite an interesting speaker like Mike Rowe (the ‘Dirty Jobs’ guy) to do one of their keynotes, I might actually attend. I’ve been going to HIMSS for nearly 15 years and just don’t care about seeing yet another CEO or politician drone on and on.”

From Four Toppled Pillars: “Re: QuadraMed. A large reduction in force happened today.” Unverified. Googling “QuadraMed + layoff” returns 2,570 hits, however, so it wouldn’t be particularly shocking. I doubt sales of QCPR, standalone scheduling systems, Affinity Revenue Cycle, or even its EMPI have been brisk.

Sexual Harassment at the HIMSS Conference

Results of my poll asking whether HIMSS conference attendees experienced unwanted sexual overtures or comments that made them uncomfortable were as follows, with 274 responses:

• 14 percent of male respondents said yes.
• 42 percent of female respondents said yes.
• Overall, 22 percent of respondents say they were made uncomfortable at the conference.

I received several comments about the poll from female attendees. One says she was appalled at the “rampant misogyny” on display. I heard stories of (married) male executives aggressively pursuing female attendees, another offering to send nude photos of himself, and another who complained that he can’t stand listening to female presenters.

Obviously the conference has a problem with making all of its attendees feel welcome and safe in a professional environment. It also seems that the majority of complaints involve vendor executives.

What, if anything, should HIMSS do about it? My suggestions, assuming that HIMSS either hasn’t done any of the following or hasn’t done a good job of promoting its efforts:

• Publish a zero-tolerance Code of Conduct anti-harassment policy for HIMSS conference participants that includes not just gender, but sexual orientation, appearance, age, race, religion, and disability. This policy should cover all official venues – the convention center, hotels, and all sanctioned events. You agree to the policy when you register to attend or exhibit.
• Define the activities that are not permissible – verbal comments relating to the above, making suggestive remarks, and showing unwanted sexual attention, for example.
• Prohibit exhibitors from using sexually related images or suggestive attire as part of the exhibitor policy.
• Allow attendees to report incidents anonymously, naming names, and have someone available to investigate their reports promptly.
• Warn those for whom sufficient evidence exists that they have violated the Code of Conduct, then expel them on the second verified report. 
• Record complaints in a permanent database to identify repeat offenders.
• Allow attendees who feel unsafe or uncomfortable to easily request help from HIMSS, conference security, or hotel security. We’re healthcare IT people – surely there’s an app out there that can offers one-click requests for help.
• Offer easy access to safe rides and physical escorts when indicated.

It’s been said that the people who roll their eyes at policies like these probably aren’t the ones who make them necessary. Hundreds of conferences have addressed the issue directly despite hesitation about potential legal issues, so surely there’s a wealth of resources for HIMSS to use in ensuring a conference environment where everyone is comfortable. Just setting expectations would be a great start.

If you agree with these ideas, sign and promote my petition to HIMSS. I didn’t include Joyce Lofstrom’s email address since it’s not really fair to swamp her inbox every time someone signs the petition, but I’ll make sure the results are known. I’ll also report back if HIMSS has had something already in the works, which is entirely possible since they’re pretty sharp.

HIStalk Announcements and Requests

Ms. Yoder from Texas reports that her kindergartners are “the most excited they have ever been since receiving our DonorsChoose package … The Read and Solve Word Problem center has been the most effective. I use it when I pull small groups during M.A.T.H for my students who are struggling with addition and subtraction. The students being able to have a hands-on center to work on this concept has increased their understanding and allowed them to master it. The Unlock It center has been very popular as well. The resources being donated to our class has given my students a real world view of how generous people can be.”

Epic Reader donated $100 to my DonorsChoose project, which with matching funds provided math manipulatives for the Canton, TX first graders of Mrs. Boggs.

I went to the county health department today to get travel immunizations. It took two hours in what could have been done in maybe 45 minutes, most of it because the employees were baffled by their new EClinicalWorks system. Checkout took 30 minutes even though nobody else was present, so I can imagine the line if they were actually busy. They had put up a sign warning that they will close 45-60 minutes early if they’ve been busy because they have to catch up in the system before going home. I suspect they didn’t train their people well, and not to perpetuate stereotypes, they were mostly older folks who said they were using their first EHR after converting from paper. The nurse apologized for staring at the screen to type instead of looking at me, but she did OK.

This week on HIStalk Practice: Morehouse School of Medicine taps Dominic Mack, MD to lead its National Center for Primary Care. IOC selects GE Healthcare health IT for 2016 Rio Games. Summit Medical Group rolls out MModal’s new outpatient CDI tools. Allscripts integrates AssistRx’s e-prescribing software into its ambulatory offerings. Florida Orthopaedic Institute Business Director Larry Bronikowski offers best practices for health IT adoption. Physicians and IT professionals take top salary spots in annual Glassdoor list. Telemedicine expansion bill heads to Indiana governor’s desk. Health2047 CEO Doug Given, MD describes the AMA-backed organization’s plans to tackle physician pain points with technology.

Webinars

March 16 (Wednesday) noon ET. “Looking at the Big Picture for Strategic Communications at Children’s Hospital Colorado.” Sponsored by Spok. Presenters: Andrew Blackmon, CTO, Children’s Hospital Colorado; Hemant Goel, president, Spok. Children’s Hospital Colorado enhanced its care delivery by moving patient requests, critical code communications, on-call scheduling, and secure texting to a single mobile device platform. The hospital’s CTO will describe the results, the lessons learned in creating a big-picture communication strategy that improves workflows, and its plans for the future.

March 16 (Wednesday) noon ET. “The Physiology of Electronic Fetal Monitoring.” Sponsored by PeriGen. Presenter: Emily Hamilton, MDCM, SVP of clinical research, PeriGen. This webinar will review the physiology of EFM – the essentials of how the fetal heart reacts to labor. The intended audience is clinicians looking to understand the underlying principles of EFM to enhance interpretation of fetal heart rate tracings.

March 22 (Tuesday) 2:00 ET. “Six Communication Best Practices for Reducing Readmissions and Capturing TCM Revenue.” Sponsored by West Healthcare Practice. Presenters: Chuck Hayes, VP of product management, West; Fonda Narke, senior director of healthcare product integration, West Healthcare Practice. Medicare payments for Transition Care Management (TCM) can not only reduce your exposure to hospital readmission penalties and improve patient outcomes, but also provide an important source of revenue in an era of shrinking reimbursements. Attendees will learn about the impacts of readmission penalties on the bottom line, how to estimate potential TCM revenue, as well as discover strategies for balancing automated patient communications with the clinical human touch to optimize clinical, financial, and operational outcomes. Don’t be caught on the sidelines as others close gaps in their 30-day post discharge programs.

Contact Lorre about our post-HIMSS webinar sale.

Sales

New York’s Care Transitions program will use Netsmart’s CareManager for care coordination and care management.

People

GE Healthcare IT names Charles Koontz (CSRA) as president and CEO. He will also serve as GE Healthcare’s chief digital officer. Predecessor Jan De Witte will leave the company.

LifeImage names Frank Brilliant (Wolters Kluwer) as SVP of sales and partnerships.

Microsoft Kinect-powered tele-rehabilitation software vendor Reflexion Health promotes interim CEO Joseph Smith, MD, PhD to the permanent role.

Announcements and Implementations

GE Healthcare’s Centricity Practice Solution is chosen as the official EHR of the Rio 2016 Olympic Games.

Memorial Sloan Kettering’s surgery center goes live with Versus RTLS to monitor patient flow through 12 ORs via Glance-and-Go whiteboards with bi-directional Epic OpTime integration.

Ochsner Baptist Medical Center (LA) goes live with PeriGen’s PeriCALM clinical decision support system.

Government and Politics

The VA awards 21 IT infrastructure upgrade contracts totaling $22.3 billion.

Technology

A Cambridge, MA startup begins shipping a $200 seizure-warning wristband containing sensors for body heat, movement, and skin conductivity following a IndieGoGo fundraising campaign last year that raised $780,000. The wristband, which buzzes to warn the wearer of an impending seizure, can also measure stress. A researcher-only version offers real-time patient monitoring. The MIT scientist who co-founded the company also co-founded a startup that detects emotion by reading a person’s facial expressions via their smartphone.

Other

Doctors at Australia’s Port Augusta Hospital write a letter to its CEO demanding that its $315 million EPAS system (provided by Allscripts) be scrapped because it is endangering patients. They cite a case in which employees failed to notice that a woman who had just given birth was bleeding because they were “preoccupied with data entry.”  The doctors also claim that log-in takes up to seven minutes, nurses mark meds as given but they still show up as due, and long-discharged patients still display as being in the waiting room. The doctors conclude that while their previous complaints were dismissed as “resisting change,’ nearly all of them use EHRs in their private practices 100 percent of the time and would like EPAS replaced  “with something much better.” Doctors at Repatriation General Hospital complained last year that EPAS cut their productivity by 50 percent. SA Health says rollouts will continue, including at the new Royal Adelaide Hospital, due to open in November. 

Nordic made a short video of HIStalkapalooza that will probably take you back a few days. Looks like our Elvis had some dance moves, although as in his 1957 Ed Sullivan appearance, he’s shown only from the waist up.

A study finds that American workers rank dead last of 18 industrial nations in using technology to solve problems, with 80 percent of us unable to figure out an error caused by transferring two-column spreadsheet data to a bar graph. Experts note that the United States is the only country where people aren’t embarrassed to say they’re not good at math.

HIMSS sent a link to its HIMSS16 conference evaluation, which was really more like an on-screen focus group given that it contained 10 pages packed with questions. I’d like to see the metric of how many people clicked the link to start the survey but who then bailed out before completing it (I can say with confidence there was at least one).

HIMSS provides a touching story of homeless US Navy veteran Kevin Phillips (center, above), sponsored to attend the HIMSS conference by the Gateway chapter. A local group helped him buy clothes appropriate for a professional conference, but an unexpected airline change on the second leg of his flight placed him on a 2 a.m. connection that required a $25 checked bag fee that he didn’t have (he had only $11 in his pocket, just enough for the hotel shuttle). He couldn’t get help, so he started walking from Chicago back home to Fort Wayne, IN. Members of the Chicago Police Department picked him up, chipped in to pay his baggage fee, and gave him a ride back to the airport. He made it to the conference and is getting career coaching through HIMSS Veterans Career Services.

Sponsor Updates

• YourCareUniverse publishes a new whitepaper, “Closing the Loop Between Chronically Ill Patients and Providers to Reduce Readmissions.”
• Ingenious Med will exhibit at South by Southwest March 11-14 in Austin, TX.
• The local business paper profiles Leidos Health’s work with the VA in light of its merger with Lockheed Martin.
• LifeImage posts video interviews from the HIMSS show floor.
• Navicure will exhibit at the MA/RI MGMA – Westborough Meeting Payer Day March 17 in West Borough, MA.
• Netsmart will exhibit at the National Association of Psychiatric Health Systems March 14 in Washington, DC.
• NTT Data will exhibit at the IT Summit – Blue Cross and Blue Shield of North Carolina March 17 in Durham, NH.
• Obix posts new Ask the Expert and System Integration videos for its perinatal software solution.
• Oneview Healthcare will exhibit during Australian Healthcare Week March 15-17 in Sydney.
• CloudWave EVP Jim Fitzgerald discusses the reasons behind Park Place International’s rebranding.
• Experian Health will exhibit at AAHAM Florida March 10-11 in Palm Coast.
• Patientco releases a new e-book, “The Healthcare Provider’s Guide to Selecting a Payment Processor.”
• RelayHealth Financial reports claim denial trends.
• The SSI Group and Streamline Health will exhibit at the 2016 NC HFMA Annual Conference March 13-15 in Pinehurst.

Blog Posts

• Local SEO: Enhancing Visibility in Your Hospital’s Target Market (Influence Health)
• Three Opportunities to Enhance Payment Security at Your Practice (InstaMed)
• What Happened In Vegas – HIMSS 2016 Takeaways (Impact Advisors)
• The Evolution of Healthcare Messaging Apps: How Far Are We From a Slack for Healthcare? (TelmedIQ)
• What We Learned at HIMSS16: Top 10 Takeaways (Spok)
• FHIRside Chat: And Now, the Difficult Questions (InterSystems)
• What do Uber and Your Integration Operations Have in Common? (Liaison Technologies)
• The Year of the Hospitalist (MedAptus)
• 4 Ways to Reduce the Number of Patient Privacy Audits (Iatric Systems)
• #HIMSS16 – CHIME CIOs discuss optimization, data, and analytics (Nordic)
• Why Not Healthcare? (PatientKeeper)
• Four Ways PatientMatters Help with Hospital Culture Change (PatientMatters)
• RCM Companies Must Have Electronic Acumen (PatientPay)
• HIPAA regulation: The myths around integrating compliance and patient care (PerfectServe)
• HIT Interoperability: Look beyond the EHR (Lexmark)
• Phynd Technologies Takes Over Las Vegas (Phynd Technologies)
• #HIMSS16 – Learning, limboing, connecting, giving [recap] (Nordic)
• It Helps When Somebody Cares (PMD)
• Population Health Management: Improving Care Delivery Systems to Achieve Better Patient Outcomes (Sagacious Consultants)
• Product Management’s Perspective at HIMSS16 (Summit Healthcare)
• Surescripts Continues to Advance and Support Healthcare Interoperability (Surescripts)

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
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EPtalk by Dr. Jayne 3/10/16

Good news from the people at Microsoft, who are listening to the user community’s pleas to return critical functionality for those using Office 365 on tablets. They’ll be adding back the ability to use the pen/stylus as a mouse. That makes me happy on multiple fronts, since not only will I be able to go back to previous workflows, but I won’t have to spend hours stripping my Surface Pro to return it to the store. There’s no ETA on the fix yet, but other than that recent failure, I really have been satisfied with my purchase.

Friday is the last day for providers and hospitals to attest for 2015 Medicare EHR Incentive Programs. If you’re on the provider side, I hope your attestation is long complete. I’ve been helping a client with a last-minute effort and we ran into a lot of issues, mostly on their side, but some with website slowness which I can only assume is due to volume. Fortunately, we finished their attestations last night and I can breathe easier going into the weekend.

Last-minute projects always make me cringe, but as a small business person, they are valuable. It’s a way to help clients in a pinch, which can bring considerable work in the future when they’re happy with your services and realize you saved their backsides. Several of my steady clients have met me while in dire straits and I’m happy to continue working with them. It can make the work unpredictable, though. I’ve been fortunate to have a couple of clinical informaticist friends that I can ask to help out when one of those situations hits or when I need coverage to take some real time off. It’s been an informal arrangement, though, and I’ve been on the fence about whether I should engage someone to work with me on a more dedicated basis.

Finding someone who knows the space in the same way I do but who isn’t already crazy busy or who doesn’t have a full-time job has been a challenge. There are a lot of inpatient CMIOs that are interested in branching out, but in order to service my clients, I needed someone with solid ambulatory experience who can also cover the softer disciplines like change leadership and team development.

After talking with multiple candidates and conducting a trial run, I’m happy to say that I officially have a partner. He’s one of my long-time mentors and I suspected that his recent retirement wouldn’t last long, so was glad to hear of his interest. It has been fun working together on projects. I’m sure that due to the difference in our ages and his more prominent career, some people might assume that I’m working for him. It’s a risk I’m willing to accept. However, my company logo (which involves a figure in a dress and stilettos with a briefcase) should make for a good icebreaker when he hands out business cards.

I’ve had quite a few emails from readers this week, which always makes me smile.

From Think Twice: “Re: MU. Your recent Curbside Consult describes all that is/was wrong with MU. Instead of ‘certifying’ systems, MU should have defined a data ontological framework, a file standard (standard XML/CCDA), and an information bus that all systems that handle PHI must comply with. In that world, we wouldn’t be certifying vendors, but rather required capabilities. It would have opened the door to innovation. I’m not sure how we would handle, app-app communication across the workflow (like SMART is supposed to address), but we’d still be much better off.  More importantly, this wouldn’t have dealt with how providers protect their data (just to keep patients inside), while using HIPAA to hide behind (another story!) Although Meaningful Use as we knew it is on the way out, there are plenty of regulatory and quasi-regulatory bodies waiting to take us to the next level as they drive towards value-based care and other buzzword-worthy initiatives. I hope they’re listening, and look at how much money has been spent vs. how many provider hours as being wasted. The recent piece on providers spending hundreds of hours keeping up with quality measures was telling (especially since we haven’t seen a commensurate uptick in patient outcomes). It may be too early to tell, but my sense from the trenches is that it hasn’t been worth it.”

From Keeping Up: “Re: HITECH. I read most of the HHS report. It’s the same garbage we hear every month about the ‘numbers’ of EPs and EHs that used a certified EHR. They may ‘use’ them, but do not attest to MU or any of the other BS. It’s the same stuff — we gave out $30 billion in incentives, EPs and EHs took that and paid it all and more to EHR vendors (they don’t say that), and it’s still a mess. The lack of vision of ONC and HHS about this is amazing to me. EPs and EHs were moving towards EHRs prior to HITECH, but instead, HHS and ONC made this artificial market. Sure, it moved the adoption needle, but to what effect? Now you have the same problems as before, but EHR vendors made a ton of money. That bubble is about to burst and it will be ugly.” He goes on to mention the lack of improved patient care, safety, security, efficiency, and costs worrying that providers will bear the blame. I don’t disagree – we’re already seeing practices who have more staff than they did five years ago but are less productive and feel like they are providing a lower quality of care. Certainly there are people who have been able to make it work, but not without a considerable amount of resources or without sacrifices at the financial or personal levels. He mentioned watching his peers leave practice due to the pressures and I’m seeing that in my community as well. Given the costs of training, the risk of burnout, and the constant external pressures, I don’t think I would recommend a career in medicine unless someone felt a true vocational calling.

From St. Elmo’s FHIR: “Re: LOINC. Regarding your comments on regulations requiring customers to use LOINC for reporting laboratory measures but not requiring lab vendors actually send the codes with the results, amen. This is one of the stupidest things that’s been done. Although you mentioned that interoperability isn’t going to change the culture of competitive advantage, eventually companies learn that interoperability isn’t in competition with this. My view is that the vendors have learned this – based on working with development teams – but it’s a time-to-market problem. The solutions they are working on today haven’t hit the market, but when they do, it will be clear that competitive advantage is built on interoperability.” As much as I’m a bit pessimistic about the future of medicine, I do want to have hope. The old adage of “knowledge is power” would seem to lead organizations to want to share as much as possible. There is a leadership training game I use called “Win All You Can,” which ultimately shows that the only way for everyone to prosper is for everyone to work together for the common good. I first ran into it during an outdoor leadership course and have used a variation of it ever since. Maybe we can get ONC to require knowledge of it (or something similar) in the next round of incentive or penalty programs.

Is interoperability really the answer? Will knowledge set us free? Email me.

Email Dr. Jayne.

Morning Headlines 3/10/16

VA names companies to share in $22 billion IT overhaul

The VA awards $22.3 billion in contracts to Booz Allen Hamilton, IBM, and Accenture as part of a department wide initiative to revamp IT systems. The project does not include funding to modernize or replace Vista, the EHR platform used by the VA.

e-MDs to Acquire Ambulatory Software Technology Assets from McKesson

E-MDs will acquire a number of McKesson ambulatory practice products, including Practice Choice, Medisoft, Lytec, and Practice Partner. Financial terms were not disclosed.

Theranos Ran Tests Despite Quality Problems

The Wall Street Journal reports that results from a 2015 CMS inspection of the Newark, California-based Theranos lab suggest that the company had been knowingly processing PT/INR tests on equipment that was generating erroneous results.

How Nash UNC improved care and added $1.5 million in revenue by deploying smartphones in the ER

UNC Nash Health Care (NC) generated $1.5 million in new revenue after issuing clinicians in the ED dedicated smart phones that were integrated with the hospital’s EHR. ED length of stay fell by 27 minutes and wait time for an inpatient bed assignment fell by 57 percent.

HIStalk Interviews Dan Michelson, CEO, Strata Decision Technology

Dan Michelson is CEO of Strata Decision Technology of Chicago, IL.

Tell me about yourself and the company.

Strata has been around for 20 years. We work with roughly one-fifth of the hospitals in the country, 185 healthcare delivery systems. The focus of the company is to help healthcare providers drive margin to fuel their mission. We do that with a cloud-based platform that hospitals deploy on top of their ERP and EHR. That platform becomes essentially a Microsoft Office for the finance team.

The other day someone used the analogy that we are kind of the Intuit for the healthcare space and that’s a good way to think of it.  Health systems use our application for financial planning — including their long-range financial plan, operating budget, and capital budget — as well as their cost accounting, where we are #1 in KLAS. Also payer contract modeling, so they can understand their true cost and true margins as they negotiate bundled care contracts.

We have algorithms that identify opportunities to reduce cost by eliminating waste, reducing unnecessary variation, and reducing the cost of harm events. Then we provide the workflow for managing that cost out. What many companies have done over the last 50 years in revenue cycle management, we’re now doing around margin management in healthcare. A typical Strata client is billion-dollar healthcare system with eight hospitals, so the opportunity to make an impact is significant.

Do  hospitals accept responsibility for their significant role in ever-rising healthcare costs?

They do now. They didn’t three years ago. The world has changed.

Cost accounting has become a required core system on the financial side to prepare for a value-based world, just as population health has become on the clinical side. People need to know their cost to negotiate bundled care contracts. Not their charge-based cost, but their true cost and their true margins. Even if they’re going to be losing money in that contract, they need to know the levers that they can pull to drive margin over time to be profitable.

That’s in the fee-for-value world, but it’s also a requirement in the fee-for-service world. Over the last three years, the average reduction in inpatient admissions nationally is 2.2 percent per year. Couple that with the fact that hospitals are operating at 2 percent margins and one-third of them are unprofitable and that’s a pretty scary future.

With that kind of pressure on the top and bottom line, the one thing that they know they need to focus on is their cost. But it’s not about just taking 5 percent or 10 percent of their cost out and then moving on. We did some research and talked to 100 different organizations. Eighty-eight percent them had a cost reduction initiative in place. The range they were looking to take out was between $50 million and $400 million, but only 17 percent of them were successful in hitting that target.

For all the automation and technology that we have around revenue cycle, it is missing on cost and margin. To make this point, I often tell people that focusing more on revenue cycle is like trying to squeeze a raisin for a little bit more juice. Cost is a like squeezing a grape — there is a lot of opportunity right now.

We have clients with 600 people in their revenue cycle organization, but only six people who are involved with performance improvement and cost. Clearly that’s going to change now that the reimbursement structure has changed and risk-based contracts are coming into the mix. Roughly 80 percent of large health systems either have a health plan or are building one. Clearly they are going to be taking on risk. The only way they can manage it long term is to understand their return.

Hospitals I’ve worked in are careful about supply costs, but not so good at managing the big-ticket items of labor management and utilization management. How are hospitals approaching cost reductions?

The state of the art for what you just described is PowerPoint and Excel. The level of sophistication is completely absent.

People approach those problems that you mentioned — managing the cost of labor, supplies, and purchased services — episodically. They go after it at one point in time with one initiative. Contrast that approach with revenue cycle, which they are looking at every hour, every day, every week.

The best organizations are approaching it now as a continuous process. They’re not approaching it as, we’ve got take out 5 percent or 10 percent of cost. They’re saying, where do we need to eliminate waste? Where do we need to eliminate variation, or at least reduce variation, or reduce unnecessary variation? Where are we doing things, like harm events, that are making matters worse?

For example, Yale New Haven Health saved $150 million taking a quality-first approach and then tying cost to it via our cost accounting solution. If they have a harm event, a PSI, or HAC, they know exactly what that’s costing them on a macro level, or even with that individual incident. They know exactly what it’s costing them. They’ve created what they called Quality Variation Indicators, QVIs, and we’ve married cost accounting data to that. They went to their clinicians, and in a very integrative fashion between physicians and finance, they’ve had conversations about cost, resources, and waste.

They’ve done two things on top of that are interesting. One is there’s some gain-sharing. If the physicians are doing better and they’re managing their resources more effectively, the physicians have some upside. Then, they’ve embedded cost within order sets, so that when a physician is placing an order within Epic, they have the cost information and are aware of it.

When you took a flight to Las Vegas, you looked up the cost on a website. There’s no such thing for somebody who works in a healthcare institution. Where would you even go to find information on cost? Two issues are holding back that scenario. The information is not accessible. Even if it may exist somewhere, people can’t get it. Second, no one is accountable. If you’re paying for a flight, regardless of work or personal, you’re going to look at that cost and look at the alternatives. We haven’t done that for clinicians.

Opening up that conversation is an enormous opportunity, especially when you understand that 80 percent of the costs in healthcare are driven by physicians and their decisions. To not provide them that information and make it accessible is crazy.

Are hospitals more freely telling physicians exactly what their true incremental cost is if they order a given test, procedure, or drug?

They’re starting. Johns Hopkins embedded costs within order sets and they drove down volume by 10 percent. University of Miami showed physicians phlebotomy costs retrospectively, and just by sharing data, they were able to drive down volume by 25 percent. We’re in the early innings of that game, but take these examples and stitch them together and you can see a path.

In 2002, people said doctors weren’t adopting EHRs because they were technophobic. It’s not like we solved technophobia in the last 14 years — it turns out that that premise was never actually correct. Then once EHRs started getting used and people saw order sets, the reaction of physicians was that it was cookbook medicine. Now you’re telling me what to do? It’s pre-prescribed? Now, when is the last time you heard the term cookbook medicine? It’s been absent for the last three or four years. That premise was wrong as well.

Now we’re operating on the third premise –that doctors don’t know and don’t care about cost. Data proves that’s not the case. A study surveyed 503 orthopedic surgeons and gave them a simple challenge. Here’s 13 commonly used implantables — guess the cost. All you have to do is get within 20 percent. The got it right 20 percent of the time. This was at Stanford, Mayo … six academic centers.

Then they asked those same physicians, if you had the cost, would you incorporate the information in your selection of a device? Eighty percent said yes. That’s two out of 10 who get the information or could guess it correctly, and eight out of 10 would use it if they had it. That gap is an enormous opportunity.

We see that conversation changing, but it’s in the early innings. People are uncomfortable at first. If they approach it as a witch hunt and a condemnation — you’re an outlier, you spend too much, there’s got to be a problem — the clinicians will say, "My patients are sicker," and then obviously, “They’re more complex and they get better outcomes.”

You have to weave together the clinical and financial, which is starting to happen now, in order to make this work. The chief medical officer at Yale, Dr. Tom Balcezak, also calls himself the medical director of finance. We’re seeing that woven together more often in more places.

As people go after value, if the top part of the value equation is quality — and quality is defined as not only clinical outcomes, but also obviously the experience of care — and the bottom part of that equation is cost, how do you deliver value if you don’t know your cost?

Here’s the problem. Even for the organizations in the past that have provided cost information, it was done on a ratio of cost to charges. It was based on the charge master, which is fiction, then taking a percentage of that, which is a made-up amount. You’re taking fiction based on fiction. It’s no wonder that nobody, including doctors, really trusted the information.

The cost accounting process historically has been run two or three times a year. It only had inpatient information, not ambulatory or outpatient information. The actionability, the accuracy, the accessibility of the data just wasn’t there.

Strata has grown rapidly and was acquired a year ago by Roper Technologies. What has changed most in the company?

Let me first talk about Roper. Roper is a publicly traded holding company that operates very similar to Berkshire Hathaway. They make investments in companies, but they let them operate independently. Roper has been around for 110 years and they own 49 companies. I believe they’ve sold one company in that history of 110 years.

The acquisition gave us the opportunity to continue down the path we were on, but with a permanent home and even more support. They don’t get involved in operational or budgeting decisions. There’s no revenue synergy or cost synergy target. There was no integration team or transition team.

It was 14 months ago when we became part of Roper and it has been everything they promised and more. It really is an amazing place to bring your company if you want to have it have permanence and continue down the path that you’re on. It’s a perfect partnership we have with Roper. I mean that sincerely.

The biggest thing that’s changed in the company is the acceleration of decision support — which is the combination of cost accounting and payer contract modeling — and the movement of the product into becoming more of a platform. What Epic or another EHR is on the clinical side, we have become on the financial side – a single database solution for all of the core operations and analytics in finance and operations. For a CFO, it’s their financial planning, budgeting, and control system. It’s their cost accounting and decision support. It’s their cost and performance management application.

We added about two years ago what we call continuous improvement, which is the ability to not only identify cost reduction opportunities or ways to use your resources more effectively, but then also the project management on top of that. We have automated cost and margin management. Because of that, the company is seen as a strategic platform versus a tactical tool set, which is how it used to be seen.

Do you have any final thoughts?

There’s an opportunity to do a tremendous amount of good here by opening up this conversation in healthcare around understanding cost and how resources are used, providing a level of sophistication around it that has been largely absent. The last 10 years of healthcare IT has been focused on the clinical side of the house and we’ve received a great benefit from that. Now we can do things that we couldn’t do before, not only sharing information, but being able to look at quality.

Clearly there’s more work to be done on the clinical side, but the missing piece is now the financial side of the house. While we’ve had all this innovation on the clinical side, we’ve fallen behind on the financial side. Now is the time to address that. Many good things will come from us all collectively doing this work.

Morning Headlines 3/9/16

US Physician Practices Spend More Than $15.4 Billion Annually To Report Quality Measures

Health Affairs publishes a study estimating that US physicians spend 785 hours and $15.4 billion per year  dealing with reporting quality measures,

Cerner Approves $300M Common Stock Buyback Plan

Cerner’s board of directors approves the repurchase of up to 5.7 million shares, or 1.7 percent of the company’s outstanding shares, at a cost of up to $300 million. No time limit was set for the completion of the buyback plan.

Analysis of Prescribers’ Notes in Electronic Prescriptions in Ambulatory Practice

A JAMA study finds that 66 percent of e-prescriptions contain information in the free text field that should have been entered as discrete data, while another 5 percent contain comments that are irrelevant to the dispensing pharmacists.

Aetna moves to combine iTriage and WellMatch, confirms layoffs

As rumored on HIStalk this weekend, Aetna has laid off an undisclosed number of employees from iTriage and merged the business unit with WellMatch, an Aetna business focused on cost transparency.

News 3/9/16

Top News

A study finds that physician practices spend 785 hours per doctor on the “unnecessarily costly” reporting of quality measures, totaling $15.4 billion annually. 

Reader Comments

From Spiffy Shades: “Re: McKesson’s ambulatory EHR/PM products. They are selling all of them to E-MDs.” McKesson will apparently exit the physician practice business by selling Medisoft, Lytec, Practice Partner, and Practice Choice to E-MDs. Marlin Equity Partners bought E-MDs in March 2015 and AdvancedMD in August 2015 to add to its MDeverywhere holding. It seems to have some synergistic plan for the hodgepodge of EHR/PM products of McKesson, which I speculate is slowly but surely divesting its way out of healthcare IT except maybe for RelayHealth.

From Robert Lafsky, MD: “Re: article on EHR free-text notes. One colleague wryly laments that a lot of doctors just use the EMR as a word processor and this is a good example. The inability to deal with structured fields seems endemic. Are we just doomed to wander the desert for 40 years until a new generation has replaced us?” A study of 26,000 electronic prescriptions that were sent to community pharmacies by community-based prescribers finds that in two-thirds of them, the prescriber placed information in the free-text field that should have instead been entered as discrete data. Nearly one in five of the prescriptions had free-text instructions that didn’t match what the prescriber actually entered. Another 10 percent of prescriptions were actually cancellation requests, sent either because the EHR vendor doesn’t support the standard cancellation message or the prescriber didn’t know how to use that function. More than half of the inappropriate free-text messages involved  insurance benefits or dispensing quantities. The authors conclude that EHR and e-prescribing vendors need to improve product design and usability testing, apparently holding prescribers harmless for using their software incorrectly.

From Dingo: “Re: HIMSS conference app. You should create one so that readers can connect with each other, see a sponsor event schedule, and find social events.” HIMSS had its own app, but I didn’t try it. I assume it focused on the educational session schedule. If you used that app, what did you like and dislike about it? If not, what kind of app would you use?

From Bill Earry: “Re: consulting companies. I’m a physician informaticist interested in exploring whether consulting is right for me. What are the qualities of a great consulting company employer? Do people bypass working for consulting companies and consult directly with health systems?” I’ve never been a consultant, so I’ll ask those who are to weigh in, especially physician consultants.

From I.C. O’Jay: “Re: innovation. It’s pointless talking to a health system CIO about innovative products. They have no interest or insight.” IT executive management is very much like public health. You’re trying to do the most good with the biggest impact given a limited budget and headcount. Do I vaccinate 1,000 children or launch a nutrition education program? Do I keep a marginal but inexpensive department system and use the money to fund a revenue cycle technology project? How should I prioritize the need to apply endless system upgrades and infrastructure projects to keep the lights on against some startup’s cool but unproven app? The hardest part about running an IT organization is enlightening departments, end users, and vendors about the constant constraints under which the organization operates – enterprise IT isn’t like buying an Office Depot computer or installing an iPhone app and it never will be. Part of the job involves watching well-meaning but naive users storm off in a huff because their shallowly-researched bright idea is not feasible given the organization’s budget, tolerance for risk, competing projects, and strategic focus. You say “no” a lot, and rightfully so. In fact, I might speculate that CIO success is predicated more on what projects they don’t undertake rather than the ones they do.

From NextGen Customer: “Re: the former hospital systems business sold to QuadraMed. During a recent conference call, a comment was made that QuadraMed bought NextGen for the customers and will not be making any enhancements. One individual said we will have to move to the other product. I contacted another NextGen customer and they said they had already been approached.” Unverified.

From Court Watcher: “Re: Epic v. Tata. There’s a new order on a motion for summary judgment. The court said there’s compelling evidence of unauthorized access by Tata’s employees over an extended period of time. The court found Tata guilty of violating the computer fraud laws and the Wisconsin computer crimes act. They also apparently violated their contracts.” I’ve written about this case a few times. Epic says Tata’s India-based employees claimed to be working for Kaiser Permanente in trying to slip into Verona-based classes and to download everything in the consultant portion of Epic’s UserWeb system for enhancement ideas for its Med Mantra hospital information system. Most of the legalese is over my head, but the Tata people seem to be real scumbags. People claim Epic is paranoid about protecting its intellectual property, but more than one example exists of people in a foreign company trying to steal Epic’s information to create a competing product.

From HIT Banker: “Re: HIMSS conference. For the last two years, one of our female junior staffers has been solicited by various male executives to join the guy in his hotel room. I wonder how much debauchery is going down behind the scenes at HIMSS? I would like to see a poll on this, although I doubt you would get honest responses. I might simply ask, ‘Did you do anything at HIMSS that you would not tell your significant other?’” What HIMSS attendees do as consenting adults is their own business, but I will modify your curiosity into this poll: did you experience unwanted sexual overtures or comments during the conference that made you uncomfortable?

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor PatientMatters. The Orlando-based company helps health systems transform the hospital patient’s financial experience with tools, training, and expertise to increase cash and lower debt as self-pay balances increase. The company focuses on seven specific areas of cash leakage: pre-registration and scheduling, ED, POS collection, patient advocacy, early-out, payment plans, and bad debt in transforming patients into educated consumers who can engage effectively. Specific tools include address verification, identity verification, eligibility, patient payment estimation, pay select, patient loans, statements, and a patient portal. One customer increased ED POS collections by 71 percent in three months, increased patient cash payments by 20 percent in six months, and decreased bad debt by 54 percent. Thanks to PatientMatters for supporting HIStalk.

I found this PatientMatters intro video on YouTube.

We fulfilled the DonorsChoose grant request of Ms. Jones from Georgia in providing her first grade class with an iPad, case, and headphones. She reports, “My students are excited about learning when they are handed an iPad, as if it was a treat or reward. Their little eyes light up and they become engaged in their learning and complete more tasks with a higher rate of success … when they are allowed to use the iPad, their confidence and self-esteem increases and more work is completed in a timely manner. This is mainly due to the immediate feedback after completing each assignment. This gives them a great sense of accomplishment.”

Also checking in was Ms. K from Tennessee, whose second graders are “having fun while learning” in using the seven math games we provided.

Listening: The Struts, Brit rockers that sound to me like a stew of Queen, Slade, and Quiet Riot. Then it’s off to some harder stuff from the amazing Avenged Sevenfold, to which I’ll be desk-drumming for the next several hours (especially since that particular song was dedicated to drummer The Rev, who died of a drug overdose in 2009 at 28).

Webinars

March 16 (Wednesday) noon ET. “Looking at the Big Picture for Strategic Communications at Children’s Hospital Colorado.” Sponsored by Spok. Presenters: Andrew Blackmon, CTO, Children’s Hospital Colorado; Hemant Goel, president, Spok. Children’s Hospital Colorado enhanced its care delivery by moving patient requests, critical code communications, on-call scheduling, and secure texting to a single mobile device platform. The hospital’s CTO will describe the results, the lessons learned in creating a big-picture communication strategy that improves workflows, and its plans for the future.

March 16 (Wednesday) noon ET. “The Physiology of Electronic Fetal Monitoring.” Sponsored by PeriGen. Presenter: Emily Hamilton, MDCM, SVP of clinical research, PeriGen. This webinar will review the physiology of EFM – the essentials of how the fetal heart reacts to labor. The intended audience is clinicians looking to understand the underlying principles of EFM to enhance interpretation of fetal heart rate tracings.

March 22 (Tuesday) 2:00 ET. “Six Communication Best Practices for Reducing Readmissions and Capturing TCM Revenue.” Sponsored by West Healthcare Practice. Presenters: Chuck Hayes, VP of product management, West; Fonda Narke, senior director of healthcare product integration, West Healthcare Practice. Medicare payments for Transition Care Management (TCM) can not only reduce your exposure to hospital readmission penalties and improve patient outcomes, but also provide an important source of revenue in an era of shrinking reimbursements. Attendees will learn about the impacts of readmission penalties on the bottom line, how to estimate potential TCM revenue, as well as discover strategies for balancing automated patient communications with the clinical human touch to optimize clinical, financial, and operational outcomes. Don’t be caught on the sidelines as others close gaps in their 30-day post discharge programs.

Contact Lorre about our post-HIMSS webinar sale.

Acquisitions, Funding, Business, and Stock

The CEO of genetic testing company Ambry Genetics makes the de-identified data of 10,000 breast and ovarian patients available to researchers, bucking the trend of biotech companies that believe they compete on data rather than testing. CEO Charlie Dunlop is blunt about his motivations: “I have stage 4 cancer myself. I don’t care what goes down. This is what we’re doing at Ambry Genetics. We’re here to try to save the world, period." The AmbryShare website defines itself as, “It’s a chance to help stop data hoarding and unlock the promise of the human genome project.”

Cerner announces a $300 million share buy-back program. Above is the one-year share price of CERN (blue, down 23 percent) vs. the Nasdaq (red, down 4 percent). Shares have dropped to July 2014 prices.

MedCity News confirms the rumors I ran here this weekend indicating that Aetna has laid off dozens of people working on its iTriage app. Aetna confirms the layoffs without providing numbers, adding that it plans to combine iTriage with its WellMatch price transparency app.

Scotland-based Craneware’s first-half profits rose 17 percent after strong sales and recurring revenue growth.

Sales

UC Irvine Health (CA) chooses Phynd to unify, manage, and share the data of its 25,000 providers across multiple IT systems.

People

Culbert Healthcare Solutions promotes Brad Boyd to president. Founder Rob Culbert relinquishes that role but remains CEO.

Nordic promotes Nicole Meidinger to VP of business development.

Announcements and Implementations

University of Texas M.D. Anderson Cancer Center (TX) goes live on Epic.

KPMG’s auditing practice will use IBM Watson to analyze customer resource allocation.

Experian Health adds its Patient Estimates solution to Athenahealth’s marketplace.

Government and Politics

ONC releases the Million Hearts EHR Optimization Guides, showing providers who use Allscripts, Cerner, or NextGen how to use their EHRs to manage aspirin therapy, blood pressure, cholesterol, and smoking cessation. ONC calls for other EHR vendors to develop guides for their products.

A Texas anesthesiologist and hospital owner is convicted of billing $10 million for supervising CRNAs when he wasn’t actually present. The government provided evidence that at the times he was supposedly working in the OR, he was actually (a) undergoing surgery himself; (b) flying on his private jet; and (c) traveling out of state. He also signed medical records attesting to the services he provided before the surgeries even started.

Wired profiles big data entrepreneur John Mininno, who has built a business around analyzing CMS-released claims data to find likely Medicare fraud, then finding an employee of the organization willing to file a whistleblower lawsuit in return for sharing any settlement. His programmers look for unusual patterns, such as providers who file a normal claim volume on a snowy day when they probably weren’t running at full capacity.

Privacy and Security

Philips launches the Netherlands-based Philips Blockchain Lab, which will explore the use of the cryptographic technology in healthcare.

An interesting article explains the motivation of shady people who post idiotic Facebook puzzles, pet photos, and emotional stories that beg users to “like them” or share them in some way. “Like-farming” attempts to rack up a ton of exposure, after which the original post is changed to either spam or malware links that pollute your own Facebook news feed as well as those of your friends in some cases. New South Wales police warned people last week of the phony contest above (posted under a fake Qantas Air account) in which Facebookers were urged to click “like” for a chance to win free travel.

A study of Android diabetes app privacy policies finds that 81 percent have no privacy policy at all and only 4 percent of them say they will ask users before sharing their data. Most apps shared insulin and blood glucose levels, and of those that offer a privacy policy, 40 percent don’t disclose that they share data.

A stolen, unencrypted laptop belonging to physician practice Premier Healthcare (IN) exposes the information of 200,000 people.

Other

Marketing firm Cramer brags about being hired by Athenahealth to create the HIMSS16 data sharing presentation of Jonathan Bush and John Halamka, developing the “relatable, human storyline,” creating a PowerPoint to “wow the audience,” and coaching the presenters through a “table read” and “two simulated on-stage rehearsals.”

A six-hospital study finds that monitoring discharged heart failure patients with telemonitoring, telephone calls, and health coaching had no effect on 180-day readmissions.

An ED doctor in England faces a disciplinary hearing after tweeting out tirades that include a proposed fine against “ambulatory neurotics with a few aches and pains” who call an “ambulance for a broken nail, an earache, period pain, not being able to sleep …” and who are “crippling the NHS.” He also tweeted, ““I’m sure ADHD is merely a polite term for a child who is just a little sh**”

Sponsor Updates

• Besler Consulting releases a new podcast, “The Relationship Between Physician Coding and Compliance.”
• Burwood Group becomes a Citrix Platinum Solution Advisor.
• Chilmark Research names Caradigm a top vendor among care management vendors.
• Premier is named to the “World’s Most Ethical Company” list for the ninth straight year.
• Spok will convert its Connect 16 annual healthcare communications conference to a series of one-day events held in six cities starting March 24.
• CitiusTech posts a new video profiling its partnership with IBM.
• CompuGroup Medical will exhibit at the National Association of Community Health Centers P&I Forum March 16-19 in Washington, DC.
• CoverMyMeds crosses the 500,000 provider account threshold, and is now integrated with over 500 EHRs.
• CTG recaps its time at HIMSS16. 
• HIMSS16 attendees help Divurgent raise $5,000 for Children’s Hospital of Nevada at UMC.
• EClinicalWorks will exhibit at AMGA 2016 Annual Conference March 10-12 in Orlando.
• The local paper looks at the ways in which API Healthcare is benefiting from its sale to GE Healthcare.
• Glytec CMO Andrew Rhinehart, MD reviews the American Diabetes Association 2016 standards of care in the latest Annals of Medicine.
• HCS will exhibit at the National Council for Behavioral Health Conference through March 9 in Las Vegas.
• SK&A publishes a report on EHR software usage in physician practices.

  Blog Posts

Blog Posts

• 3 Post ICD-10 Transition Solutions for Your Practice (AdvancedMD)
• Organizational Health Part 2 (Optimum Healthcare IT)
• How to Innovate Without Losing Control (AirStrip)
• What a HIMSS-sane week! (NextGen Healthcare)
• What does population health mean to you? The view from HIMSS16 (Forward Health Group)
• How do We Secure Mobility at the Speed of Innovation? (AirWatch)
• Optimization Governance (Impact Advisors)
• 8 Tips to Help You Transition From ICD-9 to ICD-10 (Aprima)
• Metabahn & HealthLoop chose Catalyze, but why? (Catalyze)
• Improving Your Financial Health Through Patient Engagement (Culbert Healthcare Solutions)
• Five Keys to Success Under the Oncology Care Model (ECG Management Consultants) 
• Marketing to Your Existing Clients to Drive Revenue (E-MDs) 
• Cisco and Extension Team Up to Tackle Modern Clinical Workflow Challenges (Extension Healthcare)
• Forms Beyond Your HER: Making it Possible for ALL Clinical Forms to be Paperless (FormFast)
• GenY4HIT – Reshaping Healthcare (Galen Healthcare Solutions)
• Insurance Carrier Setup Neglect: A Costly Oversight (Part 2 of 2) (Hayes Management Consulting)
• Epic Service Desk: Why Should an Organization Invest? (The HCI Group)
• How to Use a Volunteer Work Day (Healthgrades)
• Innovation at HIMSS is all About Interoperability (Healthwise)

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
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Morning Headlines 3/8/16

Walgreens looks to cut ties with Theranos

Financial Times reports that Walgreens is moving forward with plans to end its relationship with Theranos in an effort to close the wellness centers Theranos runs in 40 of its Arizona pharmacy locations.

‘The data is being collected—now it needs to move’

In a short interview, National Coordinator Karen DeSalvo, MD discusses MARCA and the unclear future of Meaningful Use Stage 3.

MD Anderson rolls out new electronic health records system

MD Anderson goes live with its Epic install. Epic was selected as vendor of choice in November 2013.

Walking Billboards for Patient-Centered Care

Patient advocate and artist Regina Holliday’s work is profiled by the Wall Street Journal.

Curbside Consult with Dr. Jayne 3/7/16

I’m still recovering from HIMSS, which really gave me a beat-down this year. What started as the usual sore throat and froggy voice from yelling over loud music and being exposed to smoke seems to be turning into something more. On top of that, my self-diagnosed broken toe is actually a pair of fractures.

Fortunately, I scheduled a fairly low-key week, so I am working from the sofa with my foot propped. I’m wading through quite a few press releases that were lost in the HIMSS shuffle. I know vendors like to save them up for the week, but then there is so much noise that they’re easily missed.

I’m also following up on some consulting leads. Although a couple of them are from actual healthcare delivery organizations, most of them are from vendors who like the idea of having a physician informaticist on call, but not necessarily having to keep them on the payroll.

I’ve enjoyed the flexibility of consulting as well as the variety. There are a lot of organizations that have problems they’re trying to solve or could benefit from some outside opinions. It’s actually a lot like being a family physician. Sometimes the problems are straightforward with obvious solutions like cold and flu symptoms. Other times the issues require a lot of analysis and diagnostic maneuvers as well as the possible intervention of other specialists. The “detective work” aspect of medicine is what attracted me to the field in the first place, so I’m glad to be able to put those skills to work in other arenas.

Having worked in the large health system space, I’ve also developed some pretty solid firefighting skills that I’m putting to use assisting a client with their 2015 Meaningful Use attestation. The deadline is Friday, and although they thought they were prepared, it turns out that their internal MU resource hadn’t really been doing much in regards to documentation. Unfortunately, this was only discovered after she left the practice. I’m helping one of their senior clinical leads understand what documentation they have, what they’re missing, and how to go about creating an attestation binder for each eligible provider. It’s not glamorous, but they’re very appreciative, so I’m enjoying the work.

ONC announced three challenges in conjunction with HIMSS. The first is for $175,000 and seeks consumer apps that use open APIs to help patients aggregate their information under their control. I saw the Humetrix iBlue Button app at last year’s HIMSS and gave it a test drive. It was straightforward and easy to use. I know there are other vendors as well, so I will be interested to see what this challenge yields.

The second challenge is for the same amount, but this time for improved user experience for providers. Eligible apps will use open APIs the improve clinical workflow.

I had worked with a vendor last year who had designed a slick-looking bolt-on documentation solution for providers. They were looking for vendor partners. I had to advise them that they’d be hard pressed to get vendors to play along with them since essentially the purpose of their product was to correct clunky and ugly workflows.

They were reluctant to admit that calling someone’s baby ugly isn’t the best way to build relationships. Instead, I advised them towards a more grassroots effort with either provider organizations or specialty societies. They’re still working on their approach. I hope to hear from them again soon, but maybe this challenge will spur even more innovation.

The third challenge is for $275,000 and supports the development of an “app discovery site” to help developers distribute their apps for providers to evaluate. The overall goal of the challenges is to leverage FHIR to build interest in open APIs while advocating user-focused innovation. I agree with them that improving in these areas is important, but don’t think we have enough money on the table yet to really move the needle.

My former health system employer decided to consolidate its clinical platforms primarily because it was tired of supporting 1,000+ applications. It feels a bit like we’re headed back in that direction — having to add on multiple third-party solutions to get the work given the increasing complexity of healthcare delivery. Not to mention that just having interoperable solutions isn’t going to motivate people to send data in a codified way that would make it truly useful.

We’re seeing issues with regulations that require customers to use LOINC for reporting laboratory measures, yet there is no requirement that lab vendors actually send LOINC codes with the results. This has put provider organizations in a bind. Although I’m grateful for the work that problem has provided my consultancy, we’d be better off if the codes were required as so many other things are.

Interoperability also isn’t going to change the culture of companies wanting to maintain competitive advantage. There’s too much at stake from a market share and financial perspective for most organizations to truly cooperate, whether they are on the vendor or provider side.

Like most patients, I’m still having to log into three or four different patient portals to track down my information. There is no incentive for the systems to share, and in some cases, the focus on accountable care organizations is making patient care less accessible as groups vie to maintain control over patients in an effort to control costs.

The Department of Health & Human Services recently released its annual Report to Congress, providing an update on the adoption of health information technology and the exchange of health information. Although it documents the progress that has been made, it also describes some key barriers, including:

• Lagging adoption by providers who were not eligible for incentives.
• Insufficient specificity of standards.
• Varying interpretation and implementation of government policies and legal requirements.
• Safety and usability issues.
• So-called “information blocking”

So far, the only real instances of information blocking I’ve seen are in the provider community, and range from lack of education in some smaller practices to activities that cry out for antitrust scrutiny. I haven’t seen much of a response to the Report, which was issued right before HIMSS. I’d be interested to hear what readers think about it.

Have you read the HHS Report to Congress? Email me.

Email Dr. Jayne.

Readers Write: Trend Watch: Innovation Forges On in the Provider Sector

Trend Watch: Innovation Forges On in the Provider Sector
By John Kelly

Provider organizations face tremendous innovation challenges. The success or failure of new systems and technology will depend on their ability to adapt and anticipate the impact of major industry changes. Looking ahead to a successful 2016, hospitals and provider organizations should still expect barriers to using EMR data, should be wary of the hype surrounding cognitive systems, and should prepare for a value-based care partnerships world where providers and payers share information in ways not imaginable until recently.

EMR data will not be fully liberated in 2016

Barriers that exist to move data in and out of EMRs will not abate in 2016, despite pressure. The business model of EMR vendors and real technological barriers will continue to thwart the goals of interoperability sought under the concept of Meaningful Use.

The good news is that providers and payers are establishing pockets of innovation using edge technologies to support better care and risk sharing based upon shared data, and the public outcry over data blocking from EHRs will eventually force vendors to adopt standard APIs. We can expect the personal health data train to gain momentum with hundreds of new market entrants, but not in 2016.

Don’t trust the hype around cognitive systems

Technology-based cognitive systems in healthcare are not in our immediate future. There is lack of clarity around the FTC’s rules regarding software that makes a medical decision — when do they have to be certified as a medical device? Without medical device certification, can the output of cognitive systems be loaded into an EMR? What about malpractice liability?

Analytics vendors and their customers have been tentative in applying the technology to direct patient care, and counter to what other prognosticators believe, this liability and the fear of the unknown will slow down the cognitive market in the US.

ACOs will invest in payer technology

Successful ACOs will require the technology to support all-payer data ingestion. They will need to see the patients as a single population, but within the context of separate payer contracts. These organizations are beginning to invest in the technology that payers have used for years to successfully acquire and integrate claims data with their population health registries.

If providers are to succeed assuming risk, it will be by employing a highly-focused health management approach that addresses the specific risks associated with specific populations of patients. Population and risk analytics infrastructure requires capital investment beyond the reach of many small and mid-size provider organizations. To encourage providers to assume greater risk for performance, payers will offer shared information exchange platforms that augment provider capabilities with analytic services.

Accountable care continues to evolve

Healthcare market transformation will gain momentum in 2016 and provider organizations should also consider the following:

• Most first-generation ACOs will fail because they don’t know what it means to truly manage risk. They do not have the ability or will to modify how they treat patients. CMS, commercial payers, and the provider community have to figure out how to hold providers harmless on what they can’t control while also rewarding them for doing the things they can do well, then help them bet on their ability to delivery consistently on their promises.
• 2016 will see an assault on post-acute care providers, who until this point have long been profitable even as many provide little relative value. This will affect nursing homes, outpatient rehabs, and even vendors who sell to post-acute care providers. The release of Medicare data for public research, particularly in the area of Medicare fraud, combined with the high-profile budget line for post-acute care will accelerate the move to overhaul the post-acute care industry.
• Finally, don’t expect a change in administration to affect CMS innovation. Regardless of the 2016 Presidential election outcome, payment reform will continue, primarily both macro-economic reasons, but importantly as well, the political reality that both parties favor fundamental reform.

John Kelly is principal business advisor at Edifecs of Bellevue, WA.

Readers Write: The Many Flavors of Interoperability

The Many Flavors of Interoperability
By Niko Skievaski

As the shift towards value-based care persists, the demand for data is as hot as ever. That means the term “interoperability” will be thrown around a lot this year. Let’s describe the various flavors in which it will inevitably be discussed. I’ve seen many conversations become confused as the context for the buzzword is mixed. Here’s an attempt at outlining the various i14y use cases. (Can we start abbreviating it like we do i18n?)

Interoperability for Care Continuity

This is the iconic use case that first comes to mind. Chronically ill patients with binders full of paper records and Ziplocs bulging with pill bottles. As patients bounce around town seeing specialists, they often need to repeat demographic data, med lists, allergies, problems, diagnoses, prior treatment, etc. The solution to this use case calls for ad hoc access to a patient’s data at the point of care. A provider’s chart doesn’t necessarily need to be synced to all other providers in the disjointed care team. Rather, the data needs to be available upon request from the relevant provider.

New payment models have fueled demand for this solution. In a fee-for-service world, redundant tests actually brought more income to the health system,  whereas in value-based models, excessive costs are eaten by the organization. This aligns the provider and patient by incentivizing only the tests and treatments that have the highest likelihood of impacting the patient’s health. Understanding the value of any given treatment also requires looking across a wide set of patients. This brings us to the second use case.

Interoperability to Measure Value

In order to understand how to pay for healthcare based on value, we must make an attempt to measure the impacts to health: a patient’s health is a function of the healthcare they receive as well as a slew of other variables. Estimating this relationship requires a magnitude more data than we’ve traditionally measured. Beyond knowing the diagnosis and treatment, we’d need to control for behavior, family history, comorbidities, prior treatments, etc. Basically everything we can know about a patient’s health. And that’s for a single patient. To build a model, we’d need this information from a large sample of patients to determine the impact of each of these variables. But as treatments are provided to patients and we receive more results, we’ll need to be updating our models to refine their accuracy over time.

Much of this data is stored in an electronic health record over the time period a patient was cared for by that health system. But it’s likely missing data from care outside of that health system. And beyond that patient, how could we combine this record with a sizable population to make a predictive (or even representative) model? Even at very large health systems, limiting their records down to the few who have a rare diagnosis for a given sex and age, the sample set can become insignificantly small.

This i14y use case requires large sets of longitudinal data, rather than single patient records in an ad hoc query. Current attempts at producing such data sets have been extremely resource intensive and normally centered around research efforts focused on a single diagnosis in a de-identified manner. We’ve also seen rampant consolidation in the industry, partially driven by the notion that taking care of larger and larger populations of patients will enable more accurate estimations of value.

Interoperability to Streamline Workflows

This i14y use case has been around since before the term garnered widespread adoption in healthcare. HL7 was created back in 1987 to develop a standard by which health data could be exchanged between the various systems deployed at a health system: electronic health records, lab information systems, radiology information systems, various devices, and pretty much everything else deployed in data center. These systems are most often tied to a centralized interface engine that acts as a translation and filtering tool bouncing transactional messages between each.

So problem solved, right? Not quite. Over the past few decades, health systems have customized their HL7 deployments just as isolated communities evolve a language into a dialect. This proves problematic as each new software application adopted by the health system requires extensive interface configuration and the precious FTE that entails. Interface teams are increasingly the most backlogged tranche of the IT department. As health systems search for more efficient ways to deliver care, they’re more often turning to cloud-based software applications because of the dramatically reduced infrastructure costs and mobility.

This use case likely requires upgraded infrastructure that allows a health system to efficiently connect with and communicate with cloud applications. The customized HL7 dialects will need to be replaced or translated into something consistent and usable for cloud applications. HL7, the organization, is currently developing FHIR as a much needed facelift to a graying standard. In the coming years we look forward to seeing more FHIR adoption in the industry, and hope to avoid the level of customization we have seen with HL7v2 — although initial feedback and documentation from EHR vendors is not promising.

Interoperability to Engage Patients

This is likely the most interesting need for i14y because of its potential. Patients don’t currently walk into doctor’s office and demand that their health data be electronically sent to applications of their choosing. But then again, where are these applications? The inability for patients to authorize API access to their health data has undoubtedly stifled the development of innovative applications. Instead, new application creation has focused on the B2B space in search of enterprise revenue.

If a patient could download an app on their phone and authorize it to pull their medical history, an army of coders would mobilize in creating apps to engage patients as consumers. Application adoption would be holistically democratized and new apps would get to market instantaneously, as opposed to the usual 18-month B2B sales cycles. Applications would be developed to help patients decipher the complexities of care, track care plans and medication adherence, and benchmark against others with similar comorbidities. They could effortlessly download and store their records and be the source of truth. They could contribute their records to research banks that would be willing to pay for their use. Widespread adoption of patient authorized access to health data would almost make the other i14y use cases moot.

Luckily, we’re getting closer. There’s mention of its mandate in MU3. One of the challenges is solving for the chicken-or-egg problem. We need enough widespread adoption of a single authentication framework and data standard to simultaneously sway the development community and health systems to adopt. MU3 seeks to force the right hand side of that equation, however failing to mandate a prescriptive framework or standard in its current draft while wavering in its timeline. As written, it’s possible that health systems can comply with differing technology making the problem only slightly better.

I’m optimistic as accelerating demand has spurred i14y innovation across the sector. HL7 is rapidly organizing support around FHIR and SMART. Incumbent integration engines are stepping up their game and outside integrators are rapidly moving into healthcare. Startups are sprouting to tackle pieces. Some health systems are proactively standing up their own i14y strategies. EHR vendors are vowing to adopt standards and roll out tools to encourage application development. I don’t doubt that we’re beginning to see the fruits of the solutions that will be adopted in the years to come. But it’s on us — as providers, technologists, developers, and patients — to continue the rally cry by demanding i14y now.

Niko Skievaski is  co-founder of Redox.